title: Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report.
abstract: OBJECTIVE
  The effect of transluminal balloon angioplasty on cerebral biochemical monitoring during treatment of severe cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated.
  
  
  METHODS
  In a 36-year-old man, an anterior communicating artery aneurysm caused an SAH (Hunt and Hess Grade IV, Fisher Grade III). After clipping, intraparenchymal monitoring (intracranial pressure, brain tissue oxygen tension [P(ti)O(2)], and microdialysis sampling of extracellular glucose, lactate, pyruvate, and glutamate) was initiated. Flow velocities obtained by transcranial Doppler sonography increased in the internal carotid artery (ICA)/middle cerebral artery bilaterally.
  
  
  METHODS
  After a decrease of P(ti)O(2) to less than 2 mm Hg and an increase of the lactate-to-pyruvate ratio to 44 in the territorial region of the left ICA, angiography demonstrated a 70 to 80% stenosis of the left ICA, which was dilated by a temporary occlusion balloon. This maneuver normalized the ICA diameter, P(ti)O(2) increased immediately from 1.5 to 40 mm Hg, the lactate-to-pyruvate ratio decreased from 44 to 30, and extracellular glucose increased from 0.4 to 0.9 mmol/L. No major changes in glutamate or intracranial pressure were seen. In the clinical follow-up, the patient showed a good recovery 6 months after SAH.
  
  
  CONCLUSIONS
  Transluminal balloon angioplasty led to a continuous and effective resolution of cerebral vasospasm observed by sustained, improved cerebral biochemical parameters. Both P(ti)O(2) and lactate-to-pyruvate ratio might provide an early diagnosis of severe cerebral vasospasm after SAH and continuous surveillance of threatened tissue regions after transluminal balloon angioplasty.
authors.affiliation: Department of Neurosurgery, Klinikum Fulda, Academic Hospital of Philips University Marburg, Fulda, Germany. hoelper@online.de
authors.forename: Bernd Manfred
authors.initials: BM
authors.lastname: Hoelper
authors.forename: Erich
authors.initials: E
authors.lastname: Hofmann
authors.forename: Roland
authors.initials: R
authors.lastname: Sporleder
authors.forename: Florian
authors.initials: F
authors.lastname: Soldner
authors.forename: Robert
authors.initials: R
authors.lastname: Behr
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D001783:Blood Flow Velocity / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D001921:Brain / Q000098:blood supply*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000503:physiopathology / Q000628:therapy; D002533:Cerebral Angiography; D004734:Energy Metabolism / Q000502:physiology*; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy*; D019289:Pyruvic Acid / Q000097:blood; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D020301:Vasospasm, Intracranial / Q000503:physiopathology / Q000628:therapy*
chemical_list: D001786:Blood Glucose; D019344:Lactic Acid; D018698:Glutamic Acid; D019289:Pyruvic Acid