gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Reconstructed computerized angiography and transluminal balloon angioplasty: promising methods in the management of severe vasospasm following SAH

Rekonstruierte computerisierte Angiographie und transluminale Ballon-Angioplastie: Vielversprechende Methoden zur Behandlung des schweren Vasospasmus nach SAB

Meeting Abstract

  • M. Janka - Klinik für Neurochirurgie, Klinikum Fulda
  • author B.M. Hoelper - Klinik für Neurochirurgie, Klinikum Fulda
  • V. Göktas - Klinik für Neurochirurgie, Klinikum Fulda
  • M. Arndt - Klinik für Neurochirurgie, Klinikum Fulda
  • L. Chone - Institut für Neuroradiologie, Klinikum Fulda
  • R. Behr - Klinik für Neurochirurgie, Klinikum Fulda

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.06.07

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Veröffentlicht: 8. Mai 2006

© 2006 Janka et al.
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Objective: Transluminal balloon angioplasty (TBA) has an important impact on the management of vasospasm after subarachnoid hemorrhage (SAH). In addition to TCD, multiplanar reconstructed computerized angiography (MPR-CTA) may be an additional tool in order to select patients for digital subtractions angiography (DSA), who run through the time of risk for vasospasm. The investigation illuminates the usefulness of MPR-CTA for the selection of patients at risk after aneurysma-clipping as well as the effect of TBA in these patients.

Methods: Since July 2004, 30 patients (80% Hunt&Hess III-V) with increased flow velocity (TCD) following clip placement were first investigated with MPR-CTA. The authors assessed the presence or absence of stenoocclusive changes in the TCD-vasospastic artery. In case of a 50% decreased calibre of the artery, DSA was performed to decide the usefulness of TBA. A follow-up of 25 patients with TBA was carried out in respect to the appearance of ischaemic lesions after TBA.

Results: 20 of 30 patients showed a significantly reduced calibre of the vasospastic artery in MPR-CTA . All of these 20 patients showed vasospasm in DSA which has to be treated by TBA. 6 of these 20 patients showed ischemia in the area supplied by the dilated artery. A less than 50% calibre change in MPR-CTA excluded two patients from DSA/TBA. Both cases had ischemic areas. 5 patients were directly transferred to DSA and TBA without MPR-CTA. Another 4 of the MRP-CTA-diagnosed patients could not be evaluated concerning calibre changes due to aneurysm-clip based artefacts. All of them revealed vasospasm in the DSA which had to be treated with TBA. Recurrent multiple TBA was performed in 4 patients. In two of them, TBA was due to recurrent vasospasm (TCD) in the same artery followed by a normalization of TCD without further ischemia. Vasospasm in different arteries needed to be treated by recurrent TBA in the other two patients.

Conclusions: MRP-CT-Angiography can be considered as an useful tool in verifying patients at risk, who are in need of endovascular treatment (TBA) after SAH and aneurysm clipping. In combination with routine-TCD, MRP-CT selects risk-patients and may reduce additional stress for patients, who are in critical condition. TBA offers a long lasting treatment for severe vasospasm after subarachnoid hemorrage, even in recurrent vasospasm in predilated arteries.