Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage

Object. Transluminal angioplasty has become a widely used adjunct therapy t o medical management of symptomatic cerebral vasospasm following subarachno id hemorrhage (SAI-I). Despite anecdotal reports of universal, angiographic ally confirmed reversal of vasospasm and high rates of clinical improvement , no rigorous examination of the efficacy of this procedure has been conduc ted. In this study the authors assess the efficacy of the aforementioned pr ocedure. Methods. Thirty-eight patients enrolled as part of the North American trial of tirilazad in aneurysmal SAH underwent transluminal angioplasty for symp tomatic cerebral vasospasm. Fifty-three percent of these patients showed go od recovery or moderate disability based on their 3-month Glasgow Outcome S cale score. Among the 38 patients who underwent angioplasty, the severity and type of v asospasm, use of papaverine in addition to balloon angioplasty, timing of t reatment, and dose of study drug did not have an effect on the outcome. The results of their neurological examinations improved in only four of the 38 patients immediately after the procedure. A conditional logistic regressio n analysis was performed in which these patients were compared with individ uals matched for age, sex, dose of study drug, admission neurological grade , and modified Glasgow Coma Scale score at the time of angioplasty. No effe ct on favorable outcomes was found for this procedure. Conclusions. Transluminal cerebral angioplasty is very effective in reversi ng angiographically confirmed vasospasm, and anecdotal reports of its clini cal utility are numerous. However, in this report the authors conclude that its superiority to medical management for symptomatic cerebral vasospasm i s questionable.