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

Case report

Bernd Manfred Hoelper, Erich Hofmann, Roland Sporleder, Florian Soldner, Robert Behr, Robert A. Solomon, J. Max Findlay, Ralph G. Dacey, DeWitte T. Cross, Jan Paul Muizelaar, Howard Yonas

Research output: Contribution to journalArticle

29 Citations (Scopus)

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 [PtiO2], 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 PtiO2 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, PtiO2 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 PtiO2 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.

Original languageEnglish (US)
Pages (from-to)970-976
Number of pages7
JournalNeurosurgery
Volume52
Issue number4
StatePublished - Apr 1 2003

Fingerprint

Balloon Angioplasty
Subarachnoid Hemorrhage
Pyruvic Acid
Angioplasty
Intracranial Vasospasm
Lactic Acid
Internal Carotid Artery
Intracranial Pressure
Brain
Glutamic Acid
Doppler Transcranial Ultrasonography
Balloon Occlusion
Glucose
Carotid Stenosis
Microdialysis
Middle Cerebral Artery
Intracranial Aneurysm
Early Diagnosis
Angiography
Oxygen

Keywords

  • Brain tissue oxygen tension
  • Cerebral vasospasm
  • Microdialysis
  • Multimodal neuromonitoring
  • Subarachnoid hemorrhage
  • Transluminal balloon angioplasty

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Hoelper, B. M., Hofmann, E., Sporleder, R., Soldner, F., Behr, R., Solomon, R. A., ... Yonas, H. (2003). Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: Case report. Neurosurgery, 52(4), 970-976.

Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage : Case report. / Hoelper, Bernd Manfred; Hofmann, Erich; Sporleder, Roland; Soldner, Florian; Behr, Robert; Solomon, Robert A.; Findlay, J. Max; Dacey, Ralph G.; Cross, DeWitte T.; Muizelaar, Jan Paul; Yonas, Howard.

In: Neurosurgery, Vol. 52, No. 4, 01.04.2003, p. 970-976.

Research output: Contribution to journalArticle

Hoelper, BM, Hofmann, E, Sporleder, R, Soldner, F, Behr, R, Solomon, RA, Findlay, JM, Dacey, RG, Cross, DT, Muizelaar, JP & Yonas, H 2003, 'Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: Case report', Neurosurgery, vol. 52, no. 4, pp. 970-976.
Hoelper, Bernd Manfred ; Hofmann, Erich ; Sporleder, Roland ; Soldner, Florian ; Behr, Robert ; Solomon, Robert A. ; Findlay, J. Max ; Dacey, Ralph G. ; Cross, DeWitte T. ; Muizelaar, Jan Paul ; Yonas, Howard. / Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage : Case report. In: Neurosurgery. 2003 ; Vol. 52, No. 4. pp. 970-976.
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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 [PtiO2], 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 PtiO2 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, PtiO2 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 PtiO2 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.",
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T1 - Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage

T2 - Case report

AU - Hoelper, Bernd Manfred

AU - Hofmann, Erich

AU - Sporleder, Roland

AU - Soldner, Florian

AU - Behr, Robert

AU - Solomon, Robert A.

AU - Findlay, J. Max

AU - Dacey, Ralph G.

AU - Cross, DeWitte T.

AU - Muizelaar, Jan Paul

AU - Yonas, Howard

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N2 - 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 [PtiO2], 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 PtiO2 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, PtiO2 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 PtiO2 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.

AB - 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 [PtiO2], 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 PtiO2 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, PtiO2 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 PtiO2 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.

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KW - Cerebral vasospasm

KW - Microdialysis

KW - Multimodal neuromonitoring

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