Chemical Infusion and Balloon Angioplasty for Vasospasm

Following haemorrhage around the brain (subarachnoid haemorrhage) from aneurysm rupture, the arteries of the brain may constrict (vasospasm) which results in a reduction in the amount of blood getting through to supply the brain. There is a risk of stroke if the spasm is severe.

A transcranial doppler (TCD) test is used to assess the velocity of blood flow within the larger arteries of the brain and is a useful guide to detecting the presence of vasospasm. In some people due to the thickness or shape of bone at the side of the skull, TCD is not possible.

An angiogram is usually performed if significant spasm is suspected. If this confirms the presence of vasospasm, two therapies are available. These are performed if there is a significant risk of stroke if the vessels are left untreated. Both procedures are usually performed under general anaesthesia and may take several hours.

1. Infusion of Verapamil or Papaverine:

this drug is infused slowly and directly into the artery(s) supplying the brain via the catheter entering via the groin. It relaxes the muscles within the artery wall which causes it to dilate allowing more blood to get through. It works on both the larger and smaller arteries of the brain and is often used in conjunction with angioplasty (see below). Its effects may be temporary and the treatment may need to be repeated.

2. Angioplasty:

this involves placing a very small, soft balloon into the arteries of the brain and slowly stretching their walls. This procedure can only be used in the larger arteries of the brain and hence papaverine is often also given to treat the smaller arteries. Angioplasty usually has a more lasting effect than papaverine alone.

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Before angioplasty After angioplasty

Potential complications include those as described for diagnostic cerebral angiography. Angioplasty carries an additional small risk of rupturing the artery.