Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm: Reversal of neurological deficits after delayed treatment

S. L. Barnwell, R. T. Higashida, V. V. Halbach, C. F. Dowd, C. B. Wilson, G. B. Hieshima

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

We used intracerebral transluminal angioplasty to treat two episodes of symptomatic vasospasm in a patient recovering from an aneurysmal subarachnoid hemorrhage. The procedures were performed after medical therapies, intravascular volume expansion, and induced arterial hypertension failed to alleviate the patient's neurological condition. The first angioplasty, confined to the right middle cerebral and distal internal carotid arteries, took place more than 30 hours after the onset of left hemiplegia. Despite the subsequent discovery of a small parietal lobe infarct, it brought about a marked improvement in left motor function and may have also limited the spread of necrotic damage. The second angioplasty was necessitated when stenotic segments of the basilar and posterior cerebral arteries caused a 24-hour decline in the patient's mental status. Although delayed in relation to the onset of symptoms, it successfully reversed the patient's comatose state. The use of transluminal angioplasty for vasospasm is generally limited to cases where it can be performed shortly after the onset of neurological symptoms; delaying the procedure increases the risk of hemorrhage from reperfused areas of infarction. Our experience with this patient demonstrates that delayed angioplasty can improve vascular flow to ischemic territory, even after infarction, without complications and with resultant improvement in neurological function.

Original languageEnglish (US)
Pages (from-to)424-429
Number of pages6
JournalNeurosurgery
Volume25
Issue number3
DOIs
StatePublished - Jan 1 1989

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm: Reversal of neurological deficits after delayed treatment'. Together they form a unique fingerprint.

  • Cite this