Chemical Angioplasty with Nitroglycerin for Vasospasm after Subarachnoid Hemorrhage: Case Series and Review
Arq. bras. neurocir; 41 (1), 2022
Publication year: 2022
Introduction Vasospasm is a common and potentially devastating complication in
patients with subarachnoid hemorrhage, causing high morbidity and mortality. There
is no effective and consistent way to prevent or treat cerebral vasospasm capable of
altering the morbidity and mortality of this complication. Animal and human studies
have attempted to show improvement in aneurysmal vasospasm. Some sought their
prevention; others, the treatment of already installed vasospasm. Some achieved only
angiographic improvement without clinical correlation, others achieved both, but with
ephemeral duration or at the expense of very harmful associated effects. Endovascular
techniques allow immediate and aggressive treatment of cerebral vasospasm and
include methods such as mechanical and chemical angioplasty. These methods have
risks and benefits.
Objectives To analyze the results of chemical angioplasty using nitroglycerin (GTN).
In addition, to performa comprehensive review and analysis of aneurysmal vasospasm.
Methods We describe our series of 77 patients treated for 8 years with angioplasty for
vasospasm, either mechanical (with balloon), chemical (with GTN) or both.
Results Eleven patients received only balloon; 37 received only GTN; 29 received
both. Forty-four patients (70.1%) evolved with delayed cerebral ischemia and 19 died (mortality of 24.7%). Two deaths were causally related to the rupture of the vessel by
the balloon. The only predictors of poor outcome were the need for external ventricular
drainage in the first hours of admission, and isolated mechanical angioplasty.
Conclusions Balloon angioplasty has excellent results, but it is restricted to proximal
vessels and is not without complications. Chemical angioplasty using nitroglycerin has
reasonable but short-lived results and further research is needed about it. It is restricted
to vasospasm angioplasties only in hospitals, like ours, where better and more potent
vasodilator agents are not available.
Hemorragia Subaracnoidea/terapia, Vasoespasmo Intracraneal/diagnóstico, Vasoespasmo Intracraneal/terapia, Vasoespasmo Intracraneal/fisiopatología, Nitroglicerina/uso terapéutico, Vasodilatadores/uso terapéutico, Angioplastia de Balón/métodos, Distribución de Chi-Cuadrado, Análisis de Supervivencia, Análisis de Regresión, Interpretación Estadística de Datos