Horiguchi Satoshi, Maki Yoshinori, Kawauchi Takeshi, Satow Takeshi, Komuro Taro
Department of Neurosurgery, Nagahama City Hospital, Nagahama, JPN.
Department of Neurosurgery, Hikone Chuo Hospital, Hikone, JPN.
Cureus. 2025 Jul 20;17(7):e88388. doi: 10.7759/cureus.88388. eCollection 2025 Jul.
Endovascular coil embolization of ruptured cerebral aneurysms during vasospasms presents technical and safety challenges. Although balloon angioplasty is typically reserved for symptomatic vasospasms, its use to facilitate endovascular procedures in asymptomatic cases has rarely been reported. We present the case of a 45-year-old man with a four-day history of persistent mild headache. He had undergone coil embolization for left- and right-middle cerebral artery (MCA) aneurysms nine years earlier. On admission, non-contrast computed tomography confirmed a subarachnoid hemorrhage. Digital subtraction angiography revealed a newly ruptured aneurysm at the right MCA bifurcation, along with a segmental vasospasm extending from the right M1 to M2 segments. Although the patient exhibited no neurological deficits, balloon angioplasty was performed to dilate the narrowed artery, thereby facilitating safe microcatheter navigation and reducing the risk of thromboembolic complications during coil embolization. The aneurysm was successfully occluded, and the patient was discharged without any new neurological deficits. This case suggests that, in select patients, balloon angioplasty may be considered to overcome anatomical challenges posed by asymptomatic vasospasm during endovascular treatment of ruptured cerebral aneurysms.
在血管痉挛期间对破裂脑动脉瘤进行血管内弹簧圈栓塞存在技术和安全挑战。尽管球囊血管成形术通常用于有症状的血管痉挛，但很少有报道将其用于促进无症状病例的血管内手术。我们报告一例45岁男性，有持续轻度头痛4天的病史。他9年前曾对左、右大脑中动脉（MCA）动脉瘤进行过弹簧圈栓塞。入院时，非增强计算机断层扫描证实有蛛网膜下腔出血。数字减影血管造影显示右侧MCA分叉处有一个新破裂的动脉瘤，同时有一段血管痉挛从右侧M1段延伸至M2段。尽管患者没有神经功能缺损，但仍进行了球囊血管成形术以扩张狭窄的动脉，从而便于安全地进行微导管操作，并降低弹簧圈栓塞期间血栓栓塞并发症的风险。动脉瘤成功闭塞，患者出院时没有出现任何新的神经功能缺损。该病例表明，在特定患者中，球囊血管成形术可被视为在破裂脑动脉瘤的血管内治疗期间克服无症状血管痉挛带来的解剖学挑战的一种方法。
