Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage–induced cerebral vasospasm

Terry, Anna R.; Zipfel, Gregory J.; Milner, Eric; Cross, DeWitte T.; Moran, Christopher J.; Diringer, Michael N.; Dacey, Ralph G.; Derdeyn, Colin P.

doi:10.3171/foc.2006.21.3.14

Cited by 58 publications

(37 citation statements)

References 22 publications

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“…10,18,23,36,39,43,48 The most feared complication is vessel rupture, which can occur when there is discordant balloon diameter to vessel size. Occasionally, in the absence of a prespasm baseline angiographic study, the "normal" size of a spastic vessel must be estimated based on anatomical assumptions.…”

Section: Intraarterial Vasodilatorsmentioning

confidence: 99%

“…The balloon is inflated distally first and then proximally, and it usually covers the length of the spastic segment. The guidewire is typically left in place during balloon inflation, which has been shown to result in lower vessel rupture risk 43 and in case distal access is necessary for replacement or repositioning of the balloon. Transluminal balloon angioplasty of cerebral vessels is done to approximately 50-90% of the original size.…”

Section: Northwestern Algorithm For Vasospasm Therapymentioning

confidence: 99%

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Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Eddleman

Hurley

Naidech

et al. 2009

FOC

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The second leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH) is delayed cerebral ischemia due to vasospasm. Although up to 70% of patients have been shown to have angiographic evidence of vasospasm, only 20–30% will present with clinical changes, including mental status changes and neurological deficits that necessitate acute management. Endovascular capabilities have progressed to become viable options in the treatment of cerebral vasospasm. The rationale for intraarterial therapy includes the fact that morbidity and mortality rates have not changed in recent years despite optimized noninvasive medical care. In this report, the authors discuss the most common endovascular options—namely intraarterial vasodilators and transluminal balloon angioplasty—from the standpoint of mechanism, efficacy, limitations, and complications as well as the treatment algorithms for cerebral vasospasm used at our institution.

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Section: Intraarterial Vasodilatorsmentioning

confidence: 99%

Section: Northwestern Algorithm For Vasospasm Therapymentioning

confidence: 99%

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Eddleman

Hurley

Naidech

et al. 2009

FOC

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“…As with hemodynamic augmentation, there have been no randomized trials of these interventions, but large case series have demonstrated angiographic and clinical improvement. 233 …”

Section: Management Of Cerebral Vasospasm and DCI After Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

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2,957

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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“…49,50,51 Balloon angioplasty remains the mainstay of treatment, with over 90% success rates and complication rates under 5%. 52 There is still a need for the development of more flexible, softer, dedicated balloons, particularly for disease involving the anterior cerebral artery. Perfusion CT shows promise for the early diagnosis of vasospasm and may obviate the need for conventional digital subtraction angiography before intervention.…”

Section: Vasospasmmentioning

confidence: 99%

Advances in Interventional Neuroradiology 2006

Pelz

Levy²,

Hopkins³

2007

Stroke

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A lthough the traditional use of intravenous (IV) thrombolytics is restricted to within 3 hours of stroke onset, the use of intra-arterial (IA) therapy is proving to be more flexible, with the ultimate time window yet to be determined. Anecdotal evidence suggests that thrombectomy may be effective beyond the 6-hour window in properly selected patients. 1 Clinical success and the incidence of complications may be more dependent on the results of perfusion-imaging and the presence of large-vessel occlusion and less on an arbitrary time window. Multimodality strategies are becoming more popular. A combination of mechanical clot retrieval and adjunctive thrombolytic therapies in 111 patients participating in the Multi MERCI trial resulted in successful recanalization in 69% of vessels versus 54% with the retriever alone. 2 The preliminary results of the IMS II trial indicate that the MicroLysus ultrasound device (EKOS Corp) may improve recanalization rates compared with standard microcatheter techniques. 3,4 Multimodal therapy combining IV or IA abciximab and intracranial angioplasty has been reported to achieve high recanalization rates, 5 and preliminary experience with intracranial stenting in acute stroke suggests that this may be an attractive adjunct to IA thrombolytics. 6,7 A retrospective review of 168 patients treated with a combination of IA thrombolytics and mechanical interventions reported recanalization in 63% and improvement in NIHSS of at least 4 points in 21% of patients at 24-hour follow-up, 8 with the highest recanalization rates seen in patients in whom 3 or more IA modalities were used. Not surprisingly, however, the rate of symptomatic intracranial hemorrhage was 14%. 8 The high morbidity and mortality rates that continue to complicate IA therapies may be attributable to the inherent selection bias toward large-vessel occlusions and the resultant initial severity of these strokes. Angioplasty and Stenting for Atherosclerosis of Extracranial and Intracranial ArteriesOver the past year, the results of 4 large extracranial carotid angioplasty (CAS) investigations have been reported. The industry supported ARCHeR and BEACH registries of nonrandomized, symptomatic and asymptomatic patients at high risk for carotid endarterectomy found 30-day stroke or death rates of 6.9% and 5.8% respectively, and ARCHeR reported a 1 year composite outcome including myocardial infarction of 9.6%. 9,10 The European EVA-3S 11 and SPACE 12 investigators reported on symptomatic patients randomized to receive either CAS or carotid endarterectomy. EVA-3S was stopped prematurely when the 30-day rate of stroke or death was significantly higher in the CAS group (9.6%) than in the carotid endarterectomy group (3.9%). In the SPACE trial, the 30-day stroke or death rate was 6.8% after CAS, and 6.3% after carotid endarterectomy, with slightly higher complication rates when embolic protection devices were used during CAS. Cerebrovascular embolization and hemodynamic changes after CAS continue to be investigated. Changes on diffus...

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Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage–induced cerebral vasospasm

Cited by 58 publications

References 22 publications

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Advances in Interventional Neuroradiology 2006

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