A therapy against vasospasm after subarachnoidal haemorrhage: clinical experience of balloon angioplasty.

Vasospasm is a phenomenon often present in human cases after subarachnoidal haemorrhage. Its aetiology and pathophysiology are unknown. As a result, cases of vasospasm do not respond to any known pharmacological therapy. We present in this paper, a practical application of intravascular surgery for vasospasm. In this procedure the requirement for a portable digital subtraction unit, transcranial Doppler sonography, and being able to determine quickly the neurological state of the patient are very important points. The use of monitoring equipment is especially indispensable during the carrying out of percutaneous transluminal angioplasty (PTA), which should be performed as soon as possible after the occurrence of vasospasm. The case of a 54-year-old male patient suffering from a ruptured anterior cerebral artery aneurysm was studied. Neck clipping was performed on the second day. On the fifth day the neurological state was stupor, and transcranial Doppler sonography (TCD) revealed a flow velocity of over 100 cm s-1. PTA was performed on the sixth day. The bilateral middle cerebral artery was dilated and the flow velocity slowed to within the normal range. The neurological state improved to clouding of consciousness after PTA. On the eighteenth day, the patient's consciousness and bilateral carotid angiograms revealed the vessels to be dilated still. It was concluded that PTA therapy, and the use of a portable digital subtraction unit and TCD sonography, for vasospasm caused by subarachnoidal haemorrhage is useful and effective.