Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: Case report

Bernd Manfred Hoelper, Erich Hofmann, Roland Sporleder, Florian Soldner, Robert Behr, Robert A. Solomon, J. Max Findlay, Ralph G. Dacey, De Witte T. Cross, J. Paul Muizelaar, Howard Yonas

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Abstract

OBJECTIVE AND IMPORTANCE: The effect of transluminal balloon angioplasty on cerebral biochemical monitoring during treatment of severe cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated. CLINICAL PRESENTATION: In a 36-year-old man, an anterior communicating artery aneurysm caused an SAH (Hunt and Hess Grade IV, Fisher Grade III). After clipping, intraparenchymal monitoring (intracranial pressure, brain tissue oxygen tension [PtiO2], and microdialysis sampling of extracellular glucose, lactate, pyruvate, and glutamate) was initiated. Flow velocities obtained by transcranial Doppler sonography increased in the internal carotid artery (ICA)/middle cerebral artery bilaterally. INTERVENTION: After a decrease of PtiO2 to less than 2 mm Hg and an increase of the lactate-to-pyruvate ratio to 44 in the territorial region of the left ICA, angiography demonstrated a 70 to 80% stenosis of the left ICA, which was dilated by a temporary occlusion balloon. This maneuver normalized the ICA diameter, PtiO2 increased immediately from 1.5 to 40 mm Hg, the lactate-to-pyruvate ratio decreased from 44 to 30, and extracellular glucose increased from 0.4 to 0.9 mmol/L. No major changes in glutamate or intracranial pressure were seen. In the clinical follow-up, the patient showed a good recovery 6 months after SAH. CONCLUSION: Transluminal balloon angioplasty led to a continuous and effective resolution of cerebral vasospasm observed by sustained, improved cerebral biochemical parameters. Both PtiO2 and lactate-to-pyruvate ratio might provide an early diagnosis of severe cerebral vasospasm after SAH and continuous surveillance of threatened tissue regions after transluminal balloon angioplasty.

Original languageEnglish
Pages (from-to)970-976
Number of pages7
JournalNeurosurgery
Volume52
Issue number4
DOIs
StatePublished - Apr 1 2003

Keywords

  • Brain tissue oxygen tension
  • Cerebral vasospasm
  • Microdialysis
  • Multimodal neuromonitoring
  • Subarachnoid hemorrhage
  • Transluminal balloon angioplasty

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    Hoelper, B. M., Hofmann, E., Sporleder, R., Soldner, F., Behr, R., Solomon, R. A., Findlay, J. M., Dacey, R. G., Cross, D. W. T., Muizelaar, J. P., & Yonas, H. (2003). Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: Case report. Neurosurgery, 52(4), 970-976. https://doi.org/10.1227/01.NEU.0000053033.98317.A3