The long-term effects of transluminal balloon angioplasty for vasospasms after subarachnoid hemorrhage: analyses of cerebral blood flow and reactivity.

Background: Transluminal balloon angioplasty (TBA) has come into wide use for management of symptomatic cerebral vasospasm after subarachnoid hemorrhage (SAH). The long-term effects of TBA in this clinical context on cerebral blood flow (CBF) and the functional properties of the arterial wall after aneurysmal SAH remain controversial. We therefore studied these effects.

Methods: All patients underwent unilateral TBA. Xenon-enhanced computed tomography was performed for an average of 18 days after TBA to measure CBF and cerebrovascular reactivity (CVR). Cerebral blood flow and CVR were compared between the side of TBA and the contralateral side.

Results: Nineteen vascular territories were treated successfully with TBA in 12 patients. Angiographic improvement of vasospasm was demonstrated in all 12 patients, and 9 (75%) patients showed neurological improvement. After balloon angioplasty, global CBF was 35.1 +/- 8.2 mL/100 g per minute, with CBF on the side with TBA (37.8 +/- 10.3 mL/100 g per minute) being essentially the same as that on the other side (P = .0671, paired Student t test). Likewise, reactivity to acetazolamide did not differ significantly between sides (P = .0817).

Conclusion: Transluminal balloon angioplasty increased proximal vessel diameters but showed no significant influence on CBF or vascular reactivity 3 weeks later. Benefits presumably were short term, but the procedure was clinically safe.