Endovascular treatment of cerebral vasospasm:: assessment of treatment effect by cerebral angiography and transcranial colour Doppler sonography

In a retrospective study of 30 consecutive patients with symptomatic vasospasm the mean degree of narrowing as compared to the initial angiogram was 35 % (+/- 24 %) in 12 intradural internal carotid arteries (ICA), 42 % (+/- 17 %) in 42 proximal middle cerebral (MCA) and 38 % (+/- 19 %) in 27 anterior cerebral arteries (ACA). The corresponding increase in mean flow velocities from baseline values obtained by transcranial colour Doppler sonography (TCD) within 12 h of the first angiogram to the time of clinical vasospasm was considerably higher, with 49 % (+/- 34 %) in the ICA, 119 % (+/- 92 %) in the MCA and 147 % (+/- 170 %) in the ACA. Following superselective intra-arterial papaverine application in 66 arteries and balloon angioplasty of 15 arteries, 78 (96.3 %) of 81 dilated. Sustained clinical improvement was achieved in 22 patients (73.3 %). The mean reversal of angiographic vasospasm was 71% for the ICA (range 10-100 %). 81 % for the MCA (range 9-100 %) and 82 % (range 0-100 %) for the Al segment. The mean reduction of flow velocities after treatment was much less with 23 % (+/- 21%) in the ICA, 32 % (+/- 24 %) in the MCA and 25 % (+/- 22 %) in the Al segment.