Distal Balloon Angioplasty of Cerebral Vasospasm Decreases the Risk of Delayed Cerebral Infarction.
Journal
AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
06
02
2019
accepted:
05
06
2019
pubmed:
20
7
2019
medline:
7
5
2020
entrez:
20
7
2019
Statut:
ppublish
Résumé
Conventional angioplasty of cerebral vasospasm combines proximal balloon angioplasty (up to the first segment of cerebral arteries) with chemical angioplasty for distal arteries. Distal balloon angioplasty (up to the second segment of cerebral arteries) has been used in our center instead of chemical angioplasty since January 2015. We aimed to assess the effect of this new approach in patients with aneurysmal SAH. The occurrence, date, territory, and cause of any cerebral infarction were retrospectively determined and correlated to angioplasty procedures. Delayed cerebral infarction, new angioplasty in the territory of a previous angioplasty, angioplasty complications, 1-month mortality, and 6- to 12-month modified Rankin Scale ≤ 2 were compared between 2 periods (before-versus-after January 2015, from 2012 to 2017) with adjustment for age, sex, World Federation of Neurosurgical Societies score, and the modified Fisher grade. Three-hundred-ninety-two patients were analyzed (160 before versus 232 after January 2015). Distal balloon angioplasty was associated with the following: higher rates of angioplasty (43% versus 27%, Our study suggests that distal balloon angioplasty is safe and decreases the risk of delayed cerebral infarction and the recurrence of vasospasm compared with conventional angioplasty. It fails to show a clinical benefit possibly because of confounding changes in adjuvant therapies of vasospasm during the study period.
Sections du résumé
BACKGROUND AND PURPOSE
Conventional angioplasty of cerebral vasospasm combines proximal balloon angioplasty (up to the first segment of cerebral arteries) with chemical angioplasty for distal arteries. Distal balloon angioplasty (up to the second segment of cerebral arteries) has been used in our center instead of chemical angioplasty since January 2015. We aimed to assess the effect of this new approach in patients with aneurysmal SAH.
MATERIALS AND METHODS
The occurrence, date, territory, and cause of any cerebral infarction were retrospectively determined and correlated to angioplasty procedures. Delayed cerebral infarction, new angioplasty in the territory of a previous angioplasty, angioplasty complications, 1-month mortality, and 6- to 12-month modified Rankin Scale ≤ 2 were compared between 2 periods (before-versus-after January 2015, from 2012 to 2017) with adjustment for age, sex, World Federation of Neurosurgical Societies score, and the modified Fisher grade.
RESULTS
Three-hundred-ninety-two patients were analyzed (160 before versus 232 after January 2015). Distal balloon angioplasty was associated with the following: higher rates of angioplasty (43% versus 27%,
CONCLUSIONS
Our study suggests that distal balloon angioplasty is safe and decreases the risk of delayed cerebral infarction and the recurrence of vasospasm compared with conventional angioplasty. It fails to show a clinical benefit possibly because of confounding changes in adjuvant therapies of vasospasm during the study period.
Identifiants
pubmed: 31320465
pii: ajnr.A6124
doi: 10.3174/ajnr.A6124
pmc: PMC7048486
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1342-1348Informations de copyright
© 2019 by American Journal of Neuroradiology.
Références
Can J Neurol Sci. 2017 Mar;44(2):152-160
pubmed: 27842615
World Neurosurg. 2019 Jan 10;:
pubmed: 30639483
Stroke. 2012 Jun;43(6):1711-37
pubmed: 22556195
J Neurosurg. 2013 Jul;119(1):180-9
pubmed: 23641823
Neurosurgery. 2008 Dec;63(6):1080-6; discussion 1086-7
pubmed: 19057319
Cerebrovasc Dis. 2016;42(1-2):97-105
pubmed: 27070952
J Neurosurg. 2010 Oct;113(4):913-22
pubmed: 19877802
J Neurointerv Surg. 2012 May;4(3):169-77
pubmed: 22374130
J Neurointerv Surg. 2018 Aug;10(8):761-764
pubmed: 29511116
Stroke. 2012 Jun;43(6):1463-9
pubmed: 22403047
Stroke. 2010 Oct;41(10):2391-5
pubmed: 20798370
Cerebrovasc Dis Extra. 2016;6(2):32-9
pubmed: 27665361
Nat Rev Neurol. 2014 Jan;10(1):44-58
pubmed: 24323051
Neurosurgery. 1998 Mar;42(3):510-6; discussion 516-7
pubmed: 9526985
Neurocrit Care. 2011 Aug;15(1):28-33
pubmed: 21360234
Stroke. 2008 Jun;39(6):1759-65
pubmed: 18420953
AJNR Am J Neuroradiol. 2017 Mar;38(3):561-567
pubmed: 27979797
Neurosurgery. 2011 Jul;69(1):95-101; discussion 102
pubmed: 21368694
Neurocrit Care. 2011 Sep;15(2):308-11
pubmed: 21748502
Vasc Endovascular Surg. 2012 Aug;46(6):460-5
pubmed: 22914892
Eur Radiol. 2017 Aug;27(8):3333-3342
pubmed: 28004163