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56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Balloon angioplasty resolves perfusion/diffusion mismatch on MRI and prevents tissue at risk from vasospastic infarction after subarachnoid hemorrhage

Die Ballondilatation verbessert eine Perfusions/Diffusions Diskrepanz im MRT und schützt Risikoareale – tissue at risk – vor vasospasmusbedingten Infarkten nach Subarachnoidalblutung

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  • corresponding author J. Beck - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • A. Raabe - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • H. Lanfermann - Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • S. Weidauer - Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-13.11

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0249.shtml

Published: May 4, 2005

© 2005 Beck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective

To analyse effects and outcome of transluminal balloon-angioplasty (TBA) on brain tissue perfusion by means of combined perfusion/diffusion weighted imaging (PWI/DWI) in patients with cerebral vasospasm after SAH.

Methods

In this prospective study 8 consecutive patients with cerebral vasospasm and TBA were included. Hemodynamically relevant vasospasm was diagnosed using a standardized PWI/DWI protocol. DSA confirmed vasospasm and TBA was used to dilate vasospastic arteries. The PWI/DWI protocol was repeated after TBA. Evaluation of contrast medium passage after standardised application with the bolus tracking method allowed calculation of time to peak (TTP) before and after TBA.

Results

Tissue at risk was diagnosed and the perfusion delays in individual vessel territories as compared to reference territories could be quantified. In cases with proximal focal vasospasm TBA could dilate spastic arteries. Follow-up PWI/DWI showed disappearance or decrease of the mismatch. Reduction of a perfusion delay of 6.6±2.1sec (mean±SEM) by TBA to 1.4±0.5sec resulted in complete prevention of infarction; reduction of a delay of 8.3±2.7 to 6.3±1.9sec resulted in survival of parts of brain tissue with only small infarcts in the vessel territories. Without TBA, however, the perfusion delay remained or even increased (10.2±2.6sec) and complete territory infarcts developed.

Conclusions

Angioplasty of vasospastic arteries leads to hemodynamic effects that can be quantified using PWI/DWI. In cases of severe PWI/DWI mismatch succesfull TBA improved tissue perfusion and prevented cerebral infarction. The clinical significance of PWI/DWI imaging and the “tissue at risk” concept is shown by cerebral infarction in vessels not accessible by TBA.