The impact of balloon angioplasty on the evolution of vasospasm-related infarction after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Vasospasm of the cerebral vessels remains a major source for morbidity and mortality after aneurysmal subarachnoid hemorrhage. The purpose of this study was to evaluate the frequency of infarction after transluminal balloon angioplasty (TBA) in patients with severe subarachnoid hemorrhage-related vasospasm.


METHODS
We studied 38 patients (median Hunt and Hess Grade II and median Fisher Grade 4) with angiographically confirmed severe vasospasm (>70% vessel narrowing). A total of 118 vessels with severe vasospasm in the anterior circulation were analyzed. Only the middle cerebral artery, including the terminal internal carotid artery, was treated with TBA (n = 57 vessel segments), whereas the anterior cerebral artery was not treated (n = 61 vessel segments). For both the treated and the untreated vessel territories, infarction on unenhanced computed tomographic scan was assessed as a marker for adverse outcome.


RESULTS
Infarction after TBA occurred in four middle cerebral artery territories (four out of 57 [7%]), whereas the infarction rate was 23 out of 61 (38%) in the anterior cerebral artery territories not subjected to TBA (P < 0.001, Fisher exact test). Three procedure-related complications occurred during TBA (dissection, n = 1; temporary vessel occlusions, n = 2). One of these remained asymptomatic, whereas this may have contributed to the development of infarction on follow-up computed tomographic scans in two cases.


CONCLUSIONS
In a population of patients with a high risk of infarction resulting from vasospasm after subarachnoid hemorrhage, the frequency of infarction in the distribution of vessels undergoing TBA amounts to 7% and is significantly lower than in vessels not undergoing TBA despite some risk inherent to the procedure.
Jestaedt
Leonie
L
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany. jestaedt@neuroradiologie.uni-wuerzburg.de
Pham
Mirko
M
Bartsch
Andreas J
AJ
Kunze
Ekkehard
E
Roosen
Klaus
K
Solymosi
László
L
Bendszus
Martin
M
D000800:Angioplasty, Balloon / Q000401:mortality*; D002544:Cerebral Infarction / Q000401:mortality* / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D020301:Vasospasm, Intracranial / Q000401:mortality* / Q000517:prevention & control*