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 Citations (Scopus)

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
StatePublished - 1989
Externally publishedYes

Fingerprint

Spasm
Angioplasty
Infarction
Posterior Cerebral Artery
Therapeutics
Parietal Lobe
Hemiplegia
Mentally Ill Persons
Internal Carotid Artery
Subarachnoid Hemorrhage
Coma
Blood Vessels
Hemorrhage
Hypertension

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Barnwell, S. L., Higashida, R. T., Halbach, V. V., Dowd, C. F., Wilson, C. B., & Hieshima, G. B. (1989). Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm: Reversal of neurological deficits after delayed treatment. Neurosurgery, 25(3), 424-429.

Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm : Reversal of neurological deficits after delayed treatment. / Barnwell, S. L.; Higashida, R. T.; Halbach, V. V.; Dowd, C. F.; Wilson, C. B.; Hieshima, G. B.

In: Neurosurgery, Vol. 25, No. 3, 1989, p. 424-429.

Research output: Contribution to journalArticle

Barnwell, SL, Higashida, RT, Halbach, VV, Dowd, CF, Wilson, CB & Hieshima, GB 1989, 'Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm: Reversal of neurological deficits after delayed treatment', Neurosurgery, vol. 25, no. 3, pp. 424-429.
Barnwell, S. L. ; Higashida, R. T. ; Halbach, V. V. ; Dowd, C. F. ; Wilson, C. B. ; Hieshima, G. B. / Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm : Reversal of neurological deficits after delayed treatment. In: Neurosurgery. 1989 ; Vol. 25, No. 3. pp. 424-429.
@article{045a743de2b246099905d41992bb7305,
title = "Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm: Reversal of neurological deficits after delayed treatment",
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.",
author = "Barnwell, {S. L.} and Higashida, {R. T.} and Halbach, {V. V.} and Dowd, {C. F.} and Wilson, {C. B.} and Hieshima, {G. B.}",
year = "1989",
language = "English (US)",
volume = "25",
pages = "424--429",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Transluminal angioplasty of intracerebral vessels for cerebral arterial spasm

T2 - Reversal of neurological deficits after delayed treatment

AU - Barnwell, S. L.

AU - Higashida, R. T.

AU - Halbach, V. V.

AU - Dowd, C. F.

AU - Wilson, C. B.

AU - Hieshima, G. B.

PY - 1989

Y1 - 1989

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0024346950&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024346950&partnerID=8YFLogxK

M3 - Article

C2 - 2528079

AN - SCOPUS:0024346950

VL - 25

SP - 424

EP - 429

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 3

ER -