EFFECTIVE MANAGEMENT OF CEREBRAL VASOSPASM WITH BALLOON ANGIOPLASTY AFTER FAILED PAPAVERINE ANGIOPLASTY

A 37 year old male with symptomatic cerebral vasospasm complicating th e rupture of a basilar tip aneurysm was initially treated with intra-a rterial papaverine in conjunction with concomitant hypervolaemia and i nduced hypertension, However, the vasospasm was only moderately improv ed, with this: effect lasting for less than 24 h, Following further ad ministration of intra-arterial papaverine, without significant angiogr aphic improvement, endovascular balloon dilatation of both vertebral a rteries 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 sta te requiring ventilatory support, to a Glasgow Coma Score of 15 in the absence of focal neurological signs (with the exception of a right oc ulomotor palsy), within 9 days. This case suggests that there may be a role for balloon dilatation angioplasty, in patients who have cerebra l vasospasm refractory to treatment with intra-arterial papaverine. (C ) Pearson Professional 1996.