Safety and efficacy of balloon angioplasty of the anterior cerebral artery for vasospasm treatment after subarachnoid hemorrhage.
Balloon angioplasty is often performed for symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. Angioplasty of the anterior cerebral artery (ACA), however, is perceived to be a challenging endeavor and not routinely performed due to technical and safety concerns. Here, we evaluate the safety and efficacy of balloon angioplasty of the anterior cerebral artery for vasospasm treatment. Patients with vasospasm following subarachnoid hemorrhage who underwent balloon angioplasty at our institution between 2011 and 2016 were retrospectively reviewed. All ACA angioplasty segments were analyzed for pre- and post-angioplasty radiographic measurements. The degree of vasospasm was categorized as mild (<25%), moderate (25-50%), or severe (>50%), and relative change in caliber was measured following treatment. Clinical outcomes following treatment were also assessed. Among 17 patients, 82 total vessel segments and 35 ACA segments were treated with balloon angioplasty. Following angioplasty, 94% of segments had increased caliber. Neurological improvement was noted in 75% of awake patients. There were no intra-procedural complications, but two patients developed ACA territory infarction, despite angioplasty treatment. We demonstrate that balloon angioplasty of the ACA for vasospasm treatment is safe and effective. Thus, ACA angioplasty should be considered to treat vasospasm in symptomatic patients recalcitrant to vasodilation infusion therapy.
Department of Neurosurgery, University of Illinois at Chicago, USA.
Nauman S
NS
Chaudhry
Department of Neurosurgery, University of Illinois at Chicago, USA.
Jennifer L
JL
Orning
Department of Neurosurgery, University of Illinois at Chicago, USA.
Sophia F
SF
Shakur
Department of Neurosurgery, University of Illinois at Chicago, USA.
Sepideh
S
Amin-Hanjani
Department of Neurosurgery, University of Illinois at Chicago, USA.
Victor A
VA
Aletich
Department of Neurosurgery, University of Illinois at Chicago, USA.
Fady T
FT
Charbel
Department of Neurosurgery, University of Illinois at Chicago, USA.
Ali
A
Alaraj
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D020771:Anterior Cerebral Artery; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy*
Anterior cerebral artery; anterior communicating artery; balloon angioplasty; subarachnoid hemorrhage; vasospasm