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Non-compliant and compliant balloons for endovascular rescue therapy of cerebral vasospasm after spontaneous subarachnoid haemorrhage: experiences of a single-centre institution with radiological follow-up of the treated vessel segments
Stroke and Vascular Neurology ( IF 4.4 ) Pub Date : 2021-03-01 , DOI: 10.1136/svn-2020-000410
Alexander Neumann 1 , Jan Küchler 2 , Claudia Ditz 2 , Kara Krajewski 2 , Jan Leppert 2 , Peter Schramm 3 , Hannes Schacht 3
Affiliation  

Background For endovascular rescue therapy (ERT) of cerebral vasospasm (CVS) due to spontaneous subarachnoid haemorrhage (sSAH), non-compliant (NCB) and compliant (CB) balloons are used with both balloon types bearing the risk of vessel injury due to specific mechanical properties. Although severe delayed arterial narrowing after transluminal balloon angioplasty (TBA) for CVS has sporadically been described, valid data concerning incidence and relevance are missing. Our aim was to analyse the radiological follow-up (RFU) of differently TBA-treated arteries (CB or NCB). Methods Twelve patients with utilisation of either NCB or CB for CVS were retrospectively analysed for clinical characteristics, ERT, functional outcome after 3 months and RFU. Compared with the initial angiogram, we classified delayed arterial narrowing as mild, moderate and severe (<30%, 30%–60%, respectively >60% calibre reduction). Results Twenty-three arteries were treated with CB, seven with NCB. The median first RFU was 11 months after TBA with CB and 10 after NCB. RFU was performed with catheter angiography in 18 arteries (78%) treated with CB and in five (71%) after NCB; magnetic resonance angiography was acquired in five vessels (22%) treated with CB and in two (29%) after NCB. Mild arterial narrowing was detected in three arteries (13%) after CB and in one (14%) after NCB. Moderate or severe findings were neither detected after use of CB nor NCB. Conclusion We found no relevant delayed arterial narrowing after TBA for CVS after sSAH. Despite previous assumptions that CB provides for more dilatation in segments adjacent to CVS, we observed no disadvantages concerning long-term adverse effects. Our data support TBA as a low-risk treatment option.

中文翻译:

非顺应性和顺应性球囊用于自发性蛛网膜下腔出血后脑血管痉挛的血管内抢救治疗:单中心机构对治疗血管段进行放射学随访的经验

背景 对于自发性蛛网膜下腔出血 (sSAH) 引起的脑血管痉挛 (CVS) 的血管内抢救治疗 (ERT),使用非顺应性 (NCB) 和顺应性 (CB) 球囊,这两种球囊类型均具有由于特定的血管损伤风险。机械性能。尽管CVS经腔内球囊血管成形术(TBA)后出现严重延迟性动脉狭窄的情况时有报道,但仍缺乏有关发生率和相关性的有效数据。我们的目的是分析不同 TBA 处理的动脉(CB 或 NCB)的放射学随访 (RFU)。方法 回顾性分析 12 例使用 NCB 或 CB 进行 CVS 的患者的临床特征、ERT、3 个月后功能转归和 RFU。与最初的血管造影相比,我们将延迟性动脉狭窄分为轻度、中度和重度(管径减少分别<30%、30%–60%、>60%)。结果 23 条动脉接受 CB 治疗,7 条动脉接受 NCB 治疗。首次 RFU 的中位时间为 TBA CB 后 11 个月,NCB 后 10 个月。在 CB 治疗后的 18 条动脉 (78%) 和 NCB 治疗后的 5 条动脉 (71%) 中通过导管血管造影进行了 RFU;在接受 CB 治疗的 5 条血管 (22%) 和接受 NCB 治疗后的 2 条血管 (29%) 中进行了磁共振血管造影。CB 后检测到 3 条动脉(13%)出现轻度动脉狭窄,NCB 后检测到 1 条动脉(14%)出现轻度动脉狭窄。使用 CB 和 NCB 后均未检测到中度或重度异常。结论 我们发现 sSAH 后 CVS TBA 后没有相关的延迟动脉狭窄。尽管之前假设 CB 会在 CVS 附近的节段提供更多扩张,但我们没有观察到长期不良反应方面的缺点。我们的数据支持 TBA 作为一种低风险的治疗选择。
更新日期:2021-03-25
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