The long-term effects of transluminal balloon angioplasty for vasospasms after subarachnoid hemorrhage: analyses of cerebral blood flow and reactivity

Murai, Yasuo; Kominami, Shushi; Kobayashi, Shiro; Mizunari, Takayuki; Teramoto, Akira

doi:10.1016/j.surneu.2004.11.036

Cited by 36 publications

(25 citation statements)

References 26 publications

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“…19 The presence of moderate or severe vasospasm at sites that had been previously treated was recorded.…”

Section: Durability Of Balloon Angioplastymentioning

confidence: 99%

Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage–induced cerebral vasospasm

Terry¹,

Zipfel²,

Milner³

et al. 2006

FOC

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Object Over the past decade, low-pressure, flow-directed balloons have been replaced by over-the-wire balloons in the treatment of vasospasm induced by subarachnoid hemorrhage (SAH). The authors assess the procedural safety and technical efficacy of these newer devices. Methods Seventy-five patients who underwent 85 balloon angioplasty procedures for the treatment of SAH-induced vasospasm were identified from a prospective quality-assurance database. Medical records and angiographic reports were reviewed for evidence of procedural complications and technical efficacy. No vessel rupture or perforation occurred, but thromboembolic complications were noted in four (4.7%) of the 85 procedures. Balloon angioplasty was frequently attempted and successfully accomplished in the distal internal carotid (100%), proximal middle cerebral (94%), vertebral (73%), and basilar (88%) arteries. Severe narrowing was present in 89 proximal anterior cerebral arteries. Angioplasty was attempted in 41 of these vessels and was successful in only 14 (34%). In 19 of the 27 unsuccessful attempts, the balloon could not be advanced over the wire due to severe vasospasm or unfavorable vessel angle. Follow-up angiography in a subset of patients demonstrated that severe recurrent vasospasm occurred in 15 (13%) of 116 vessels studied after angioplasty. Conclusions Over-the-wire balloons involve a low risk for vessel rupture. The anterior cerebral artery remains difficult to access and successfully treat with current devices. Further improvements in balloon design, such as smaller inflated diameters and better tracking, are necessary. Finally, thromboembolic complications remain an important concern, and severe vasospasm may recur after balloon angioplasty.

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“…19 The presence of moderate or severe vasospasm at sites that had been previously treated was recorded.…”

Section: Durability Of Balloon Angioplastymentioning

confidence: 99%

Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage–induced cerebral vasospasm

Terry¹,

Zipfel²,

Milner³

et al. 2006

FOC

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“…Éste puede evaluarse indirectamente por la mejoría clínica o directamente mediante estudios de flujo sanguíneo cerebral antes y después del tratamiento. A pesar de que se han publicado excelentes resultados angiográficos de la ATP (mejoría angiográfica cercana al 100%) 18,19 , sus resultados clínicos son variables y las tasas de mejoría neurológica oscilan entre el 31 y el 93% tras el tratamiento [20][21][22] . En una extensa revisión de la literatura, Hoh et al 21 estimaron que el 62% de los pacientes mejoraron de su déficit neurológico tras la angioplastia.…”

Section: Eficacia Clínica Y Resultadosunclassified

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Alcázar

González

Romance³

2008

Medicina Intensiva

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El vasospasmo cerebral es una de las principales causas de morbimortalidad en los pacientes con hemorragia subaracnoidea por rotura de un aneurisma cerebral. Cuando el vasospasmo se hace resistente al tratamiento médico máximo, el tratamiento endovascular es una opción terapéu-tica para incrementar el flujo sanguíneo cerebral y evitar lesiones isquémicas cerebrales. Los rápi-dos avances en técnicas endovasculares permiten utilizar la angioplastia transluminal percutá-nea y la infusión intraarterial de diversos fármacos vasodilatadores para revertir el vasospasmo. En este artículo se revisan las diferentes técnicas endovasculares disponibles y se describen sus mecanismos de acción, técnicas de administración, resultados clínicos y complicaciones. ENDOVASCULAR TREATMENT OF CEREBRAL VASOSPASM DUE TO ANEURYSMAL SUBARACHNOID HEMORRHAGECerebral vasospasm remains a leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. When vasospasm becomes refractory to maximal medical treatment, endovascular therapies may be considered as an option to increase cerebral blood flow to prevent cerebral infarction. Endovascular techniques include transluminal balloon angioplasty and intraarterial infusion of vasorelaxants.This article reviews the various endovascular techniques for the treatment of cerebral vasospasm and discusses the mechanisms of action, techniques of administration, clinical results, and limitations of these treatment strategies.

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“…18 Firlik, et al, 17 noted 100% angiographic improvement in all 13 patients who underwent balloon angioplasty. Murai, et al, 38 noted 100% angiographic improvement in all 12 of their patients, in whom 19 vascular territories were treated. Although balloon angioplasty improves the caliber of the vasospastic vessel, the efficacy of treatment is better defined by the clinical outcomes and CBF measurements.…”

Section: Clinical Effects and Outcomesmentioning

confidence: 94%

“…Many authors have reported sustained clinical improvement and reversal of delayed ischemic neurological deficits, with treatment efficacy ranging anywhere from 11 to 92%. 5,13,17,18,38,39,44,55,63 In a review of the literature, Hoh and Ogilvy 23 reported clinical improvement in 328 (62%) of 530 patients treated with balloon angioplasty. Some reports show that favorable results can be achieved when angioplasty is initiated early after the onset of clinical vasospasm.…”

Section: Clinical Effects and Outcomesmentioning

confidence: 99%

“…Hoh and Ogilvy 23 reported an overall improvement in CBF in 92 (85%) of 108 patients in their review of a group who had undergone angioplasty since 1985. However, Murai, et al.,38 noted no significant influence on CBF after balloon angioplasty. At the 3-week follow-up visit, global CBF was 35.1 Ϯ 8.2 ml/100 g/min, with CBF on the side treated with angioplasty (37.8 Ϯ 10.3 ml/100 g/min) essentially the same as that on the other side.…”

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confidence: 96%

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Update on endovascular therapies for cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage

Sayama¹,

Liu²,

Couldwell³

2006

FOC

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✓Cerebral vasospasm remains a major source of morbidity and death in patients with aneurysmal subarachnoid hemorrhage (SAH). When vasospasm becomes refractory to maximal medical management consisting of induced hypertension and hypervolemia and administration of calcium channel antagonists, endovascular therapies should be considered. The primary goal of endovascular treatment is to increase cerebral blood flow to prevent cerebral infarction. Two of the more frequently studied endovascular treatments are transluminal balloon angioplasty and intraarterial papaverine infusion. These two have been used either alone or in combination for the treatment of vasospasm. Other pharmacological vasodilating agents currently being investigated are intraarterial nimodipine, nicardipine, verapamil, and milrinone. Newer intraarterial agents, such as fasudil and colforsin daropate, have also been investigated. In this article the authors review the current options in terms of endovascular therapies for treatment of cerebral vasospasm. The mechanism of action, technique of administration, clinical effect and outcomes, and complications of each modality are discussed.

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The long-term effects of transluminal balloon angioplasty for vasospasms after subarachnoid hemorrhage: analyses of cerebral blood flow and reactivity

Cited by 36 publications

References 26 publications

Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage–induced cerebral vasospasm

Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage–induced cerebral vasospasm

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Update on endovascular therapies for cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage

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