EFFECT OF TRANSLUMINAL ANGIOPLASTY ON CEREBRAL BLOOD-FLOW IN THE MANAGEMENT OF SYMPTOMATIC VASOSPASM FOLLOWING ANEURYSMAL SUBARACHNOID HEMORRHAGE

In this study the authors have examined the effects of transluminal an gioplasty on cerebral blood flow (CBF) in the management of intractabl e vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Fourte en consecutively enrolled patients underwent attempted angioplasty wit h or without intraarterial infusion of papaverine. Twelve patients und erwent pre- and postangioplasty xenon-enhanced computerized tomography (Xe-CT) scanning to measure regional CBF in 55 to 65 regions of inter est (ROIs) per patient. Angioplasty was possible in 13 (93%) of 14 pat ients, with angiographically demonstrated improvement in all 13. Twelv e (92%) of the 13 patients were neurologically improved following angi oplasty; seven (58%) of the 12 patients who improved had a complete re versal of all delayed ischemic deficits. Angioplasty significantly dec reased the mean number of ROIs at risk (11.4 ROIs pre- and 0.9 ROIs po stangioplasty) (p < 0.00005, t-test). All patients had a reduction in the number of ROIs at risk after angioplasty; six (50%) of 12 no longe r had any ROIs remaining at risk after angioplasty. Angioplasty signif icantly increased the mean CBF within at-risk ROIs (13 ml/100 g/minute pre- and 44 ml/100 g/minute postangioplasty) (p < 0.00005, t-test). A ll patients experienced an improvement in mean CBF in at-risk ROIs aft er angioplasty, with the mean CBF improving to above 20 ml/100 g/minut e in all cases. No differences in the degree of improvement were found in patients who received intraarterial papaverine compared with those who did not. In the majority of patients with refractory vasospasm fo llowing SAH, angioplasty effectively dilated spastic arteries, reverse d delayed neurological deficits? and significantly improved CBF in are as of brain at risk of infarction.