Multimodal quantitation of the effects of endovascular therapy for vasospasm on cerebral blood flow, transcranial doppler ultrasonographic velocities, and cerebral artery diameters

被引:48
作者
Oskouian, RJ
Martin, NA
Lee, JH
Glenn, TC
Guthrie, D
Gonzalez, NR
Afari, A
Vinuela, F
机构
[1] Univ Calif Los Angeles, Sch Med, Div Neurosurg, Los Angeles, CA 90024 USA
[2] Univ Calif Los Angeles, Sch Med, Cerebral Blood Flow Lab, Los Angeles, CA USA
[3] Harvard Univ, Sch Med, Boston, MA USA
[4] Yale Univ, Sch Med, New Haven, CT USA
[5] Univ Calif Los Angeles, Div Intervent Neuroradiol, Los Angeles, CA USA
关键词
balloon angioplasty; cerebral vasospasm; intra-arterial papaverine infusion; subarachnoid hemorrhage;
D O I
10.1097/00006123-200207000-00005
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: The goal of this study was to quantify the effects of endovascular therapy on vasospastic cerebral vessels. METHODS: We reviewed the medical records for 387 patients With ruptured intracranial aneurysms who were treated at a single institution (University of California, Los Angeles) between May 1, 1993, and March 31, 2001. Patients who developed cerebral vasospasm and underwent cerebral arteriographic, transcranial Doppler ultrasonographic, and cerebral blood flow (CBF) studies before and after endovascular therapy for cerebral arterial spasm (vasospasm) were included in this study. RESULTS: Forty-five patients fulfilled the aforementioned criteria and were treated with either papaverine infusion, papaverine infusion with angioplasty, or angioplasty alone. After balloon angioplasty (12 patients), CBF increased from 27.8 +/- 2.8 ml/100 g/min to 28.4 +/- 3.0 ml/100 g/min (P = 0.87); the middle cerebral artery blood flow velocity 9.4 cm/s and decreased to 76.3 +/- 9.3 cm/s (P < 0.05) with a mean was 157.6 increase in cerebral artery diameters of 24.4%. Papaverine infusion (20 patients) transiently increased the CBF from 27.5 +/- 2.1 ml/100 g/min to, 38.7 +/- 2.8 ml/100 g/min (P < 0.05) and decreased the middle cerebral artery blood flow velocity from 109.9 +/- 9.1 cm/s to 82.8 +/- 8.6 cm/s (P < 0.05). There was a mean increase in vessel diameters of 30.1%- after papaverine infusion. Combined treatment (13 patients) significantly increased the CBF from 33.3 +/- 3.2 ml/100 g/min to 41.7 +/- 2.8 ml/100 g/min (P < 0.05) and decreased the transcranial Doppler velocities from 148.9 +/- 12.7 cm/s to 111.4 +/- 10.6 cm/s (P < 0.05), with a mean increase in vessel diameters of 42.2%. CONCLUSION: Balloon angioplasty increased proximal vessel diameters, whereas papaverine treatment effectively dilated distal cerebral vessels. In our small series, we observed no correlation between early clinical improvement or clinical outcomes and any of our quantitative or physiological data (CBF, transcranial Doppler velocities, or vessel diameters).
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页码:30 / 41
页数:12
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