Efficacy of Balloon Angioplasty in the Treatment of Vasospasm after Aneurysmal SAH

Abstract

Vasospasm of the cerebral vessels remains a major source for morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the frequency of infarction after transluminal balloon angioplasty (TBA) in patients with severe SAH-related vasospasm. 20 consecutive patients with angiographically confirmed vasospasm (median Hunt & Hess grade II, median Fisher grade IV) were included in this study. Treatment consisted of TBA in severe vasospasm of the middle cerebral artery (MCA), whereas vasospasm of the anterior cerebral artery (ACA) was not considered for TBA and served as a control group. A total of 30 MCA segments revealing extensive vasospasm were treated with TBA. In 33 ACA segments severe vasospasm was present. For both vessel territories cerebral infarction on follow-up CT was assessed as a marker of adverse outcome. In the MCA territory, infarction occurred after TBA in two of 30 vessels (7%). In the ACA territory 14 of 33 ACA territories with confirmed severe vasospasm developed infarction (42%). This was a significantly lower rate of infarction in the TBA group (p < 0.001, Fisher’s exact test). In a population of patients with a high risk for vasospasm-related infarction after SAH the frequency of infarction in vessel territories after TBA amounts to 7% and is considerably lower than in vessels with vasospasm not undergoing TBA.