title: Cerebral arterial angioplasty in a patient with Loeys-Dietz syndrome.
abstract: A 14-year-old boy with Loeys-Dietz syndrome (LDS) had an acute neurologic decline 6 days after a subarachnoid hemorrhage. Cerebral angiography at presentation did not show an aneurysmal source of the hemorrhage. However, on post-bleed day 6 the patient experienced an acutely worsening headache and subsequently lost consciousness. Head CT showed new subarachnoid blood and repeat angiography demonstrated a basilar tip aneurysm. Endovascular coil embolization was performed and his neurologic status improved postoperatively until post-bleed day 9 when he became unresponsive. A CT angiogram demonstrated severe proximal vasospasm. After an unsuccessful attempt to treat the vasospasm medically, the patient was transported to the neurointerventional suite for intra-arterial vasodilator treatment, which also failed to ameliorate the vasospasm. The endovascular surgeons were then faced with the conundrum of attempting a high-risk cerebral angioplasty in a pediatric patient with LDS or returning to maximal medical treatment for severe refractory vasospasm.
authors.affiliation: Department of Neurosurgery, Columbia University, New York, New York, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Kellner
authors.affiliation: Department of Neurosurgery, Columbia University, New York, New York, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Sussman
authors.affiliation: Department of Neurosurgery, Columbia University, New York, New York, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: Department of Neurological Surgery, Columbia University, New York, New York, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: Department of Neurosurgery, Columbia University, New York, New York, USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
mesh_terms: D000293:Adolescent; D017130:Angioplasty / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology / Q000628:therapy*; D055947:Loeys-Dietz Syndrome / Q000150:complications*; D008297:Male
keywords: Aneurysm; Angiography; Angioplasty; Balloon