title: Comparison between angioplasty using compliant and noncompliant balloons for treatment of cerebral vasospasm associated with subarachnoid hemorrhage.
abstract: BACKGROUND
  Considerable controversy exists regarding the choice of balloon used for performing angioplasty as treatment of cerebral vasospasm associated with subarachnoid hemorrhage.
  
  
  OBJECTIVE
  To determine the impact of compliant and noncompliant balloons on angiographic and clinical outcomes among patients with subarachnoid hemorrhage-related cerebral vasospasm.
  
  
  METHODS
  Consecutive patients with cerebral vasospasm who underwent balloon angioplasty were included. Patient characteristics, rate of angiographic recurrence, and occurrence of cerebral infarcts in the affected vessel distribution were compared between arteries treated using different balloons.
  
  
  RESULTS
  A total of 30 patients underwent a first-time angioplasty using compliant (n = 34) or noncompliant (n = 51) balloons. At admission, patients were classified Hunt and Hess grade I to III (n = 20) and Hunt and Hess grade IV to V (n = 10). Fisher grades in patients were I (n = 1), II (n = 3), III (n = 20), and IV (n = 6). No significant differences in the rate of angiographic recurrence (32% vs 53%; P = .14), need for repeat angioplasty (21% vs 20%; P = .97), and occurrence of cerebral infarcts in the affected arterial distribution (21% vs 10% P = .39) were observed with compliant and noncompliant balloons, respectively. Independent of the balloon type, a significant reduction in the need for repeat angioplasty was observed when the initial angioplasty resulted in a normal or supranormal diameter compared with a subnormal diameter (63.5% vs 36.5%; P = .01).
  
  
  CONCLUSIONS
  No clear difference was observed between compliant and noncompliant balloons for therapeutic angioplasty in preventing angiographic recurrence or the need for repeat angioplasty in patients with subarachnoid hemorrhage-related cerebral vasospasm. An immediate normal or supranormal vessel diameter after the first-time angioplasty resulted in a significant reduction in the need for repeat angioplasty.
authors.affiliation: Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, Minnesota 55455, USA. miley011@umn.edu
authors.forename: Jefferson T
authors.initials: JT
authors.lastname: Miley
authors.forename: Nauman
authors.initials: N
authors.lastname: Tariq
authors.forename: Fotis G
authors.initials: FG
authors.lastname: Souslian
authors.forename: Naeem
authors.initials: N
authors.lastname: Qureshi
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Ramachandra P
authors.initials: RP
authors.lastname: Tummala
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vazquez
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000601:surgery*