RESUMO
Cerebral vasospasm is a significant cause of morbidity and mortality associated with aneurysmal subarachnoid hemorrhage (aSAH). Intra-arterial chemical and mechanical angioplasty, performed alone or in combination, have been shown to ameliorate cerebral vasospasm and improve patient outcomes. Few options exist for patients who fail these traditional endovascular tactics. We propose a hybrid microcatheter technique that combines the mechanical benefit of transient high pressure induced by microcatheter fluid bolus with a low-dose vasodilator infusion. Five patients with moderate to severe symptomatic vasospasm who failed medical and traditional endovascular management were treated using a hybrid microcatheter technique. All angioplasty procedures were technically successful, and the degree of vasospasm improved following angioplasty. There were no complications related to the cerebral angioplasty procedures. None of the patients required repeat endovascular intervention. Hybrid microcatheter angioplasty may be a useful complement to mechanical or pharmacological techniques in the endovascular management of intractable cerebral vasospasm after aSAH.
RESUMO
Cerebral vasospasm is a significant cause of morbidity and mortality associated with aneurysmal subarachnoid hemorrhage (aSAH). Intra-arterial chemical and mechanical angioplasty, performed alone or in combination, have been shown to ameliorate cerebral vasospasm and improve patient outcomes. Few options exist for patients who fail these traditional endovascular tactics. We propose a hybrid microcatheter technique that combines the mechanical benefit of transient high pressure induced by microcatheter fluid bolus with a low-dose vasodilator infusion. Five patients with moderate to severe symptomatic vasospasm who failed medical and traditional endovascular management were treated using a hybrid microcatheter technique. All angioplasty procedures were technically successful, and the degree of vasospasm improved following angioplasty. There were no complications related to the cerebral angioplasty procedures. None of the patients required repeat endovascular intervention. Hybrid microcatheter angioplasty may be a useful complement to mechanical or pharmacological techniques in the endovascular management of intractable cerebral vasospasm after aSAH.
RESUMO
The technique of balloon-assisted tracking (BAT) has been demonstrated in transradialcardio-angiographic procedures. Using three commonly encountered clinicalscenarios, we outline the technical details of BAT for managing peripheral and cerebralinterventions with challenging vascular access. We describe methods used toovercome vasospasm, stenosis and vascular shelves during interventions for acuteischemic stroke, but these issues are not unique to neuroendovascular cases and thetechniques can be applied across all endovascular interventions. We present threeacute stroke interventions where anatomic challenges were overcome with the useof endovascular BAT. This article describes a novel application for BAT techniques inendovascular interventions to assist with access in peripheral, cervical and intracranialvessels. These methods can also be used to improve access during diagnosticcerebral angiography. BAT is a useful adjunct when navigating catheters throughvasospasm, tortuous anatomy, vascular step-offs or intraluminal plaques.