Effective management of cerebral vasospasm with balloon angioplasty after failed papaverine angioplasty

Abstract

A 37 year old male with symptomatic cerebral vasospasm complicating the rupture of a basilar tip aneurysm was initially treated with intra-arterial papaverine in conjunction with concomitant hypervolaemia and induced hypertension. However, the vasospasm was only moderately improved, with this effect lasting for less than 24 h. Following further administration of intra-arterial papaverine, without significant angiographic improvement, endovascular balloon dilatation of both vertebral arteries and basilar artery resulted in dramatic and sustained reversal of angiographic vasospasm. The patient's clinical condition improved dramatically after this procedure, progressing from an unconscious state requiring ventilatory support, to a Glasgow Coma Score of 15 in the absence of focal neurological signs (with the exception of a right oculomotor palsy), within 9 days. This case suggests that there may be a role for balloon dilatation angioplasty, in patients who have cerebral vasospasm refractory to treatment with intra-arterial papaverine.