Original ArticleSafety and Efficacy of Noncompliant Balloon Angioplasty for the Treatment of Subarachnoid Hemorrhage–Induced Vasospasm: A Multicenter Study
Introduction
Balloon angioplasty is an established technique for treatment of symptomatic large artery vasospasm after subarachnoid hemorrhage (SAH) that is refractory to hyperdynamic therapy.1, 2 Angioplasty involves the use of 1 of 2 types of balloons: compliant or noncompliant. The term “compliant” refers to the property by which a balloon's diameter (and volume) increases in response to an increase in inflation pressure.3 Although the radial force exerted by a noncompliant balloon on the parent artery's endothelial wall is greater than that of a compliant balloon, insufflation of the balloon is typically associated with a less dramatic increase in diameter.4 Similarly, the maximum inflation volume for these devices is finite, which allows for greater operator control of the balloon diameter during inflation.4 However, noncompliant balloons are more rigid compared with compliant balloons,5 raising the theoretical possibility that noncompliant balloon catheters may require sturdier microwire access for successful navigation and carry a greater level of difficulty in navigation and a higher risk of wire perforation compared with compliant balloons. Whether noncompliant balloons compare favorably with compliant balloons in the treatment of cerebral vasospasm is largely unknown. In this article, we report the efficacy and safety of noncompliant balloon angioplasty for treatment of cerebral vasospasm at 3 major academic institutions in the United States.
Section snippets
Materials and Methods
After institutional review board approval was obtained, 3 major academic institutions in the United States provided data on cerebral vasospasm treated with noncompliant balloon angioplasty between October 2004 and February 2016. Baseline characteristics (sex, age, and smoking history), SAH grade (Hunt and Hess grade and modified Fisher score), aneurysm characteristics (size and location), aneurysm treatment (microsurgical clipping vs. endovascular embolization), balloon angioplasty procedure
Baseline Characteristics
Noncompliant balloon angioplasty for SAH-induced cerebral vasospasm was performed in 52 patients (median age 50 years; range, 27–73 years; 71.2% female) during the period 2004–2016 at 3 participating institutions (Figure 1). A history of smoking was reported by 35 (67.3%) patients. Aneurysmal SAH was present in 50 patients, whereas the SAH was from an unknown source in 2 patients. Of patients, 37 (71.2%) presented with a Hunt and Hess grade of 3–5, and 47 (90.4%) had a modified Fisher score of
Discussion
In the present study, we assessed the safety and efficacy of balloon angioplasty for SAH-induced vasospasm using noncompliant balloons at 3 major academic centers in the United States. To our knowledge, this is the largest study to date. There was improvement in angiographic vasospasm in 97% of cases without any associated procedural morbidity or mortality.
Conclusions
This multicenter, retrospective analysis found that noncompliant balloon angioplasty is safe and effective in improving radiographic vasospasm. The fixed diameter of the noncompliant balloon may limit the incidence of dissections and other intraoperative complications. No predictors of angioplasty success were identified on multivariate analysis. The rate of DCI in territories supplied by vessels that underwent angioplasty was highest in the ACA territory and lowest in the posterior circulation.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Apar S. Patel and Christoph J. Griessenauer are co–first authors.