Balloon angioplasty for the treatment of vasospasm: results of first 50 cases

Neurosurgery. 1998 Mar;42(3):510-6; discussion 516-7. doi: 10.1097/00006123-199803000-00016.


Objective: To report the results of the first 50 consecutive patients with vasospasm secondary to subarachnoid hemorrhage treated with balloon angioplasty after failure of medical management.

Methods: Retrospective uncontrolled study of 50 consecutive patients treated with balloon angioplasty between February 1988 and July 1992. Forty-six had objective clinical deterioration despite maximal medical therapy, whereas four were treated on the basis of rapidly accelerating transcranial Doppler velocities and decreased regional blood perfusion detected by technetium-99m-exametazime brain single photon emission computed tomography. All patients had evidence of marked vasospasm demonstrated by angiography. Thirty-two (64%) and 46 (92%) patients underwent angioplasty within 12 and 18 hours, respectively.

Results: Of the patients with clinical evidence of vasospasm-induced ischemia, 28 (61%) showed sustained neurological improvement within 72 hours of angioplasty. Three (6%) patients deteriorated within 72 hours after angioplasty, with two (4%) patients dying immediately after angioplasty as a result of vessel rupture and the other patient's Glasgow Coma Scale score decreasing by 2. Two additional patients in poor condition with Hunt and Hess Grade V at the time of angioplasty subsequently died during hospitalization. Two other patients died as a result of unclipped aneurysms that subsequently bled 4 and 12 days after angioplasty, respectively. The improvement demonstrated clinically, angiographically, and by transcranial Doppler after angioplasty was sustained, with only one patient requiring subsequent angioplasty of a previously dilated segment (total, 170 vessel segments dilated). Two patients developed vasospasm in previously undilated segments.

Conclusion: Timely balloon angioplasty can reverse delayed ischemic deficit caused by vasospasm in patients for whom medical therapy has failed.

MeSH terms

  • Angioplasty, Balloon* / instrumentation
  • Cerebral Angiography
  • Equipment Design
  • Humans
  • Ischemic Attack, Transient / diagnosis
  • Ischemic Attack, Transient / etiology
  • Ischemic Attack, Transient / therapy*
  • Radiopharmaceuticals
  • Retreatment
  • Retrospective Studies
  • Subarachnoid Hemorrhage / complications
  • Technetium Tc 99m Exametazime
  • Tomography, Emission-Computed, Single-Photon
  • Tomography, X-Ray Computed
  • Ultrasonography


  • Radiopharmaceuticals
  • Technetium Tc 99m Exametazime