Abstract
Patients presenting with symptomatic intracranial arterial vasospasm are now being treated by interventional neurovascular techniques in selected cases. From a percutaneous transfemoral approach, a custom-designed silicone microballoon can be guided through the intracranial vessels, and inflated to dilate the spastic vessel(s). This technique has been useful for both focal and diffuse areas of spasm. In clinical trials, 28 patients, ranging in age from 15–73 years have been treated. A total of 99 vascular territories have been successfully dilated in both the anterior and posterior circulations. Clinical improvement following treatment was observed in 17 cases (60.7%). Technical complications directly related to therapy included 2 cases (7.1%) of vessel rupture. In long term clinical follow-up 17 patients (60.7%) had good to excellent outcome, 2 patients (7.1%) remained in poor condition, and 9 patients (32.1%) died despite therapy. In patients presenting with symptomatic intracranial arterial vasospasm who are unresponsive to medical therapy, treatment by balloon angioplasty techniques may help to improve cerebral perfusion and clinical outcome of the patient.
Similar content being viewed by others
References
Aaslid R, P Huber, H Nornes: Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60 (1984) 37–41
Alksne JF, JH Greenhoot: Experimental catecholamine-induced chronic cerebral vasospasm. Myonecrosis in vessel wall. J Neurosurg 41 (1974) 140–445
Allcock JM, CG Drake: Ruptured intracranial aneurysms — the role of arterial spasm. J Neurosurgery 22 (1965) 21–29
Allen GS, HS Ahn, TJ Preziosi et al: Cerebral arterial spasm: A controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 308 (1983) 619–624
Block PC, RK Myler, S Stertzer et al: Morphology after transluminal angioplasty in human beings. N Engl J Med 305 (1985) 382–385
Bockenheimer SA, K Mathias: Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNR 4 (1983) 791–792
Brothers MF, RC Holgate: Intracranial angioplasty for treatment of vasospasm after subarachnoid hemorrhage: technique and modifications to improve branch access. AJNR 11(2) (1990) 239–248
Chavez L, A Takashi, T Yoshimoto et al: Morphological changes in normal canine basilar arteries after transluminal angioplasty. Neurol Research 12 (1990) 12–16
Conway LW, LW McDonald: Structural changes of the intradural arteries following subarachnoid hemorrhage. J Neurosurg 37 (1972) 715–723
Dotter CT, MP Judkins: Transluminal treatment of arteriosclerotic obstruction: description of a new technique and a preliminary report of its application. Circulation 30 (1964) 654–670
DuBoulay G: Distribution of spasm in the intracranial arteries after subarachnoid haemorrhage. Acta Radiologica (Diagn) 1 (1963) 257–266
Echlin F: Experimental vasospasm, acute and chronic, due-to blood in the subarachnoid space. J Neurosurg 35 (1971) 646–656
Ecker A, A Riemenschneider: Arteriographic demonstration of spasm of the intracranial arteries. With special reference to saccular arterial aneurysms. J Neurosurg 8 (1951) 660–667
Fein JM, WJ Flor, SL Cohan et al: Sequential changes of vascular ultrastructure in experimental cerebral vasospasm. Myonecrosis of subarachnoid arteries. J Neurosurg 41 (1974) 49–58
Findlay JM, BK Weir, K Kanamaru et al: The effect of timing of intrathecal fibrinolytic therapy on cerebral vasospasm in a primate model of subarachnoid hemorrhage. Neurosurgery 26 (1990) 201–206
Fisher CM, JP Kistler, JM Davis: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6 (1980) 1–9
Flamm ES, HP Adams, DW Beck et al: Doseescalation study of intravenous nicardipine in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 64 (1988) 393–400
Graf CJ, DW Nibbelink: Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: report on a randomized treatment and study. Stroke 5 (1974) 557–601
Higashida RT, VV Halbach, LD Cahan et al: Transluminal angioplasty for treatment of intracranial arterial vasospasm. J Neurosurg 71 (1989) 648–653
Higashida RT, VV Halbach, B Dormandy, J Bell, M Brant-Zawadzki, GB Hieshima: New microballoon device for transluminal angioplasty of intracranial arterial vasospasm. AJNR 11(2) 1990:233–238
Higashida RT, VV Halbach, CF Dowd et al: Treatment of intracranial arterial spasm by interventional neurovascular techniques. Neuroradiology 33 (1991) 421–423
Konishi Y, E Maemura, H Yokota et al: Treatment of cerebral vasospasm with dilation balloon catheter: basic study of percutaneous transluminal angioplasty. In: Wilkins RH (ed): Cerebral Vasospasm. Raven Press, New York (1988) 509–511
Konishi Y, M Tookitsu, E Sato et al: Percutaneous transluminal angioplasty for vasospasm after subarachnoid hemorrhage. In: Sano K, K Takakura, NF Kassell, T Sasaki (eds): Cerebral Vasospasm: Proceedings of the IVth International Conference on Cerebral Vasospasm. University of Tokyo Press, 1990
Mayberg M, J Eskridge, D Newell, HR Winn: Angioplasty for symptomatic vasospasm. In: Sano K, K Takakura, NF Kassell, T Sasaki (eds): Cerebral Vasospasm: Proceedings of the IVth International Conference on Cerebral Vasospasm. University of Tokyo Press, 1990
Mayberg MR, T Okada, DH Bark: The significance of structural changes in cerebral arteries after subarachnoid hemorrhage. J Neurosurg 72 (1990) 626–633
Mizukami M, T Kawase, T Usami et al: Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10 (1982) 301–307
Nemoto S, T Abe, H Tanaka et al: Percutaneous transluminal angioplasty for cerebral vasospasm following subarachnoid hemorrhage. In: Sano K, Takakura K, NF Kassell, T Sasaki (eds): Cerebral Vasospasm: Proceedings of the IVth International Conference on Cerebral Vasospasm. University of Tokyo Press, 1990
Newell DW, JM Eskridge, MR Mayberg et al: Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg 71 (1989) 654–660
Pile-Spellman J, A Berenstein, T Liczak, K Baker: The effect of angioplasty on canine cerebral vessels: Acute physiological and anatomical changes. Presented at the 25th Annual Meeting of the American Society of Neuroradiology, New York 1987
Ropper AH, NT Zervas: Outcome one year after subarachnoid hemorrhage from cerebral aneurysms. J Neurosurg 60 (1984) 909–915
Sahs A, GE Perret, HB Locksley, H Nishioka: Intracranial aneurysm and subarachnoid hemorrhage. Philadelphia, JB Lippincott Co 1969
Smith RR, BR Clower, GM Grotendorst et al: Arterial wall changes in early human vasospasm. Neurosurgery 16 (1985) 171–176
Smith RR, JJ Conners, Y Yamamoto, DH Bernanke: Balloon angioplasty for vasospasm: Theoretical and practical considerations. In: Sano K, K Takakura, NF Kassell, T Sasaki (eds): Cerebral Vasospasm: Proceedings of the IVth International Conference on Cerebral Vasospasm. University of Tokyo Press 1990
Takahashi A, T Yoshimoto, K Mizoi, T Sugawara, Y Fujii: Transluminal Balloon Angioplasty for Vasospasm after subarachnoid hemorrhage. In: Sano K, K Takakura, NF Kassell, T Sasaki (eds): Cerebral Vasospasm: Proceedings of the IVth International Conference on Cerebral Vasospasm. University of Tokyo Press 1990
Tanabe Y, K Sakata, H Yamada et al: Cerebral vasospasm and ultrastructural changes in cerebral arterial wall. An experimental study. J Neurosurg 49 (1978) 229–238
Zubkov YN, BM Nikiforov, VA Shustin: Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir 70 (1984) 665–679
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Higashida, R.T., Van Halbach, V., Dowd, C.F. et al. Intravascular balloon dilatation therapy for intracranial arterial vasospasm: patient selection, technique, and clinical results. Neurosurg. Rev. 15, 89–95 (1992). https://doi.org/10.1007/BF00313501
Issue Date:
DOI: https://doi.org/10.1007/BF00313501