Safety and Efficacy of Noncompliant Balloon Angioplasty for the Treatment of Subarachnoid Hemorrhage–Induced Vasospasm: A Multicenter Study

OBJECTIVE: Cerebral vasospasm following subarachnoid hemorrhage is the most important cause of neurologic decline after successful treatment of the ruptured aneurysm. We report safety and efficacy of noncompliant balloon angioplasty for treatment of cerebral vasospasm. METHODS: Three major U.S. academic institutions provided data on cerebral vasospasm treated with noncompliant balloon angioplasty between October 2004 and February 2016. Baseline characteristics, procedure details, and radiographic and clinical outcome data were collected and analyzed. RESULTS: There were 52 patients (median age 50 years; range, 27-73 years) who underwent 165 noncompliant balloon angioplasty procedures. Balloon angioplasty was performed most frequently in the middle cerebral artery (MCA) (49.1%) followed by the internal carotid artery (27.2%). Improvement in vasospasm severity occurred in 160 arteries (97.0%) without procedure-related complications. No independent predictor of angioplasty success was identified on multivariate analysis. Delayed cerebral ischemia occurred in 24 patients (46.2%) encompassing 36 vascular territories. The rate of delayed cerebral ischemia in territories supplied by vessels that underwent angioplasty at least once was 29.4%, 24.2%, 19.3%, and 0% for the anterior cerebral artery (ACA) territory, internal carotid artery territory (ACA, ACA/MCA watershed, or MCA), MCA territory, and posterior circulation. CONCLUSIONS: Our data suggest that noncompliant balloon angioplasty for treatment of subarachnoid hemorrhage-induced cerebral vasospasm is safe and effective. No predictors of angioplasty success were identified. The rate of delayed cerebral ischemia in territories supplied by vessels that underwent angioplasty was highest in the ACA territory and lowest in the posterior circulation.