Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report.

Abstract

OBJECTIVE AND IMPORTANCE:

The effect of transluminal balloon angioplasty on cerebral biochemical monitoring during treatment of severe cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated.

CLINICAL PRESENTATION:

In a 36-year-old man, an anterior communicating artery aneurysm caused an SAH (Hunt and Hess Grade IV, Fisher Grade III). After clipping, intraparenchymal monitoring (intracranial pressure, brain tissue oxygen tension [P(ti)O(2)], and microdialysis sampling of extracellular glucose, lactate, pyruvate, and glutamate) was initiated. Flow velocities obtained by transcranial Doppler sonography increased in the internal carotid artery (ICA)/middle cerebral artery bilaterally.

INTERVENTION:

After a decrease of P(ti)O(2) to less than 2 mm Hg and an increase of the lactate-to-pyruvate ratio to 44 in the territorial region of the left ICA, angiography demonstrated a 70 to 80% stenosis of the left ICA, which was dilated by a temporary occlusion balloon. This maneuver normalized the ICA diameter, P(ti)O(2) increased immediately from 1.5 to 40 mm Hg, the lactate-to-pyruvate ratio decreased from 44 to 30, and extracellular glucose increased from 0.4 to 0.9 mmol/L. No major changes in glutamate or intracranial pressure were seen. In the clinical follow-up, the patient showed a good recovery 6 months after SAH.

CONCLUSION:

Transluminal balloon angioplasty led to a continuous and effective resolution of cerebral vasospasm observed by sustained, improved cerebral biochemical parameters. Both P(ti)O(2) and lactate-to-pyruvate ratio might provide an early diagnosis of severe cerebral vasospasm after SAH and continuous surveillance of threatened tissue regions after transluminal balloon angioplasty.

• Authors: Bernd Manfred Hoelper, Erich Hofmann, Roland Sporleder, Florian Soldner, Robert Behr
• Journal: Neurosurgery (Neurosurgery) Vol. 52 Issue 4 Pg. 970-4; discussion 974-6 (Apr 2003) ISSN: 0148-396X [Print] United States
• PMID: 12657196 (Publication Type: Case Reports, Journal Article)

Chemical References

• Blood Glucose
• Lactic Acid
• Glutamic Acid
• Pyruvic Acid

Topics

• Adult
• Angioplasty, Balloon
• Blood Flow Velocity (physiology)
• Blood Glucose (metabolism)
• Brain (blood supply)
• Carotid Artery, Internal
• Carotid Stenosis (physiopathology, therapy)
• Cerebral Angiography
• Energy Metabolism (physiology)
• Glutamic Acid (metabolism)
• Humans
• Intracranial Aneurysm (surgery)
• Lactic Acid (blood)
• Male
• Oxygen Consumption (physiology)
• Postoperative Complications (physiopathology, therapy)
• Pyruvic Acid (blood)
• Subarachnoid Hemorrhage (surgery)
• Vasospasm, Intracranial (physiopathology, therapy)