Terry Anna, Zipfel Gregory, Milner Eric, Cross DeWitte T, Moran Christopher J, Diringer Michael N, Dacey Ralph G, Derdeyn Colin P
Department of Neurological Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Neurosurg Focus. 2006 Sep 15;21(3):E14. doi: 10.3171/foc.2006.21.3.14.
Over the past decade, low-pressure, flow-directed balloons have been replaced by over-the-wire balloons in the treatment of vasospasm induced by subarachnoid hemorrhage (SAH). The authors assess the procedural safety and technical efficacy of these newer devices.
Seventy-five patients who underwent 85 balloon angioplasty procedures for the treatment of SAH-induced vasospasm were identified from a prospective quality-assurance database. Medical records and angiographic reports were reviewed for evidence of procedural complications and technical efficacy. No vessel rupture or perforation occurred, but thromboembolic complications were noted in four (4.7%) of the 85 procedures. Balloon angioplasty was frequently attempted and successfully accomplished in the distal internal carotid (100%), proximal middle cerebral (94%), vertebral (73%), and basilar (88%) arteries. Severe narrowing was present in 89 proximal anterior cerebral arteries. Angioplasty was attempted in 41 of these vessels and was successful in only 14 (34%). In 19 of the 27 unsuccessful attempts, the balloon could not be advanced over the wire due to severe vasospasm or unfavorable vessel angle. Follow-up angiography in a subset of patients demonstrated that severe recurrent vasospasm occurred in 15 (13%) of 116 vessels studied after angioplasty.
Over-the-wire balloons involve a low risk for vessel rupture. The anterior cerebral artery remains difficult to access and successfully treat with current devices. Further improvements in balloon design, such as smaller inflated diameters and better tracking, are necessary. Finally, thromboembolic complications remain an important concern, and severe vasospasm may recur after balloon angioplasty.
在过去十年中，低压、血流导向球囊已被导丝球囊所取代，用于治疗蛛网膜下腔出血（SAH）所致的血管痉挛。作者评估了这些新型器械的操作安全性和技术有效性。
从一个前瞻性质量保证数据库中确定了75例接受85次球囊血管成形术治疗SAH所致血管痉挛的患者。回顾病历和血管造影报告，以寻找操作并发症和技术有效性的证据。未发生血管破裂或穿孔，但在85例手术中有4例（4.7%）出现血栓栓塞并发症。在颈内动脉远端（100%）、大脑中动脉近端（94%）、椎动脉（73%）和基底动脉（88%）频繁尝试并成功完成了球囊血管成形术。89条大脑前动脉近端存在严重狭窄。其中41条血管尝试进行血管成形术，仅14条（34%）成功。在27例未成功的尝试中，有19例由于严重血管痉挛或血管角度不佳，球囊无法沿导丝推进。对部分患者进行的随访血管造影显示，在血管成形术后研究的116条血管中，有15条（13%）出现严重复发性血管痉挛。
导丝球囊导致血管破裂的风险较低。大脑前动脉目前仍难以通过现有器械进行操作和成功治疗。需要进一步改进球囊设计，如更小的膨胀直径和更好的跟踪性能。最后，血栓栓塞并发症仍然是一个重要问题，球囊血管成形术后严重血管痉挛可能复发。
