BACKGROUND: Considerable controversy exists regarding the choice of balloon used for performing angioplasty as treatment of cerebral vasospasm associated with subarachnoid hemorrhage (SAH).
OBJECTIVE: To determine the impact of compliant and non-compliant balloons on angiographic and clinical outcomes among patients with SAH related cerebral vasospasm.
METHODS: Consecutive patients with cerebral vasospasm who underwent balloon angioplasty were included. Patient characteristics, rate of angiographic recurrence, and occurrence of cerebral infarcts in the affected vessel distribution were compared between arteries treated using different balloons.
RESULTS: A total of 30 patients underwent a first time angioplasty using compliant (n= 34) or non-compliant (n=51) balloons. At admission, patients were classified Hunt-Hess I-III (n=20) and Hunt-Hess grade IV-V (n=10). The Fisher grade was I (n=1), II (n=3), III (n=20), and IV (n=6). No significant differences in the rate of angiographic recurrence (32% vs. 53%; p=0.14), need for repeat angioplasty (21% vs. 20%; p=0.97), and occurrence of cerebral infarcts in the affected arterial distribution (21% vs. 10% p=0.39) were observed with compliant and non-compliant balloons, respectively. Independent of the balloon type, a significant reduction in need for repeat angioplasty was observed when the initial angioplasty resulted in a normal or supranormal diameter compared to a subnormal diameter (63.5% vs. 36.5%; p=0.01).
CONCLUSION: No clear difference was observed between compliant and non-compliant balloons for therapeutic angioplasty in preventing angiographic recurrence or need for repeat angioplasty in patients with SAH related cerebral vasospasm. An immediate normal or supranormal vessel diameter after the first time angioplasty resulted in a significant reduction in need for repeat angioplasty.