Non-compliant and compliant balloons for endovascular rescue therapy of cerebral vasospasm after spontaneous subarachnoid haemorrhage: experiences of a single-centre institution with radiological follow-up of the treated vessel segments

Abstract

BackgroundFor endovascular rescue therapy (ERT) of cerebral vasospasm (CVS) due to spontaneous subarachnoid haemorrhage (sSAH), non-compliant (NCB) and compliant (CB) balloons are used with both balloon types bearing the risk of vessel injury due to specific mechanical properties. Although severe delayed arterial narrowing after transluminal balloon angioplasty (TBA) for CVS has sporadically been described, valid data concerning incidence and relevance are missing. Our aim was to analyse the radiological follow-up (RFU) of differently TBA-treated arteries (CB or NCB).MethodsTwelve patients with utilisation of either NCB or CB for CVS were retrospectively analysed for clinical characteristics, ERT, functional outcome after 3 months and RFU. Compared with the initial angiogram, we classified delayed arterial narrowing as mild, moderate and severe (<30%, 30%–60%, respectively >60% calibre reduction).ResultsTwenty-three arteries were treated with CB, seven with NCB. The median first RFU was 11 months after TBA with CB and 10 after NCB. RFU was performed with catheter angiography in 18 arteries (78%) treated with CB and in five (71%) after NCB; magnetic resonance angiography was acquired in five vessels (22%) treated with CB and in two (29%) after NCB. Mild arterial narrowing was detected in three arteries (13%) after CB and in one (14%) after NCB. Moderate or severe findings were neither detected after use of CB nor NCB.ConclusionWe found no relevant delayed arterial narrowing after TBA for CVS after sSAH. Despite previous assumptions that CB provides for more dilatation in segments adjacent to CVS, we observed no disadvantages concerning long-term adverse effects. Our data support TBA as a low-risk treatment option.

Continuous Intraarterial Nimodipine Infusion for the Treatment of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Retrospective, Single-Center Cohort Trial

“…Although this study, aimed at investigating CIAN and was not a RCT, we decided to include these patients anyway (as they underwent CIAN), as the previous procedures (TBA/IAN) for different reasons did not yield the desired results or were aborted at an early time point. It is well-known that other studies report TBA to be a safe and effective in the treatment of LVV (45,46), and that from the few TBA cases included in this study no conclusion regarding the efficacy of TBA can be drawn. Interestingly, other devices like stentretrievers normally used for thrombectomy (47) and adjustable remodeling meshes developed to aid in aneurysm coiling (48) are currently being investigated for endovascular treatment of severe vasospasm.…”

Neuroradiological diagnosis and therapy of cerebral vasospasm after subarachnoid hemorrhage

“…Und zwar entweder primär bei rezidivierenden ZVS nach vorheriger Nimodipin-Instillation oder sekundär als Ergänzung zur intraarteriellen Nimodipingabe, wenn das angiografische Ansprechen allein hierauf nicht ausreichend war (< 50 % Gefäßerweiterung im Vergleich zum ursprünglichen Angiogramm, sofern dort noch keine ZVS vorlagen). Bei der BA kommen zur endovaskulären Behandlung von ZVS sowohl nicht-nachgiebige (non-compliant) als auch nachgiebige (compliant) Ballonkatheter zur Anwendung, an deren systematischen Vergleichen es bislang noch mangelt [52,66]. Die BA birgt prinzipiell das Risiko für schwere periprozedurale Komplikationen wie thrombembolische Infarkte undgerade auch im Gegensatz zur rein intraarteriellen medikamentösen Behandlung -Gefäßrupturen, bei allerdings deutlichen Unterschieden in der Angabe zu deren Vorkommen (0-15 %) [52,[66][67][68][69].…”

“…Bei der BA kommen zur endovaskulären Behandlung von ZVS sowohl nicht-nachgiebige (non-compliant) als auch nachgiebige (compliant) Ballonkatheter zur Anwendung, an deren systematischen Vergleichen es bislang noch mangelt [52,66]. Die BA birgt prinzipiell das Risiko für schwere periprozedurale Komplikationen wie thrombembolische Infarkte undgerade auch im Gegensatz zur rein intraarteriellen medikamentösen Behandlung -Gefäßrupturen, bei allerdings deutlichen Unterschieden in der Angabe zu deren Vorkommen (0-15 %) [52,[66][67][68][69]. Den Ergebnissen eigener Studien nach sind übrigens auch nach BA in einer nicht vernachlässigbaren Rate Rezidive von ZVS zu finden [52].…”

“…Systematic comparisons are not yet available. 52 66 . In principle, BA carries the risk of severe periprocedural complications like thromboembolic infarctions and – especially in contrast to the purely intraarterial administration of medication – vascular rupture.…”

“…In principle, BA carries the risk of severe periprocedural complications like thromboembolic infarctions and – especially in contrast to the purely intraarterial administration of medication – vascular rupture. However, there are significant differences in the literature regarding frequency (0–15 %) 52 66 67 68 69 . According to the results of our own studies, a non-negligible rate of recurrence of CVS can be seen after BA 52 .…”