Balloon angioplasty vs. chemical angioplasty for treatment of delayed cerebral ischaemia: a comparison of brain tissue oxygenation
EANS Academy. Al-Ahmad S. 09/25/19; 275897; EP01017
Selma Al-Ahmad
Selma Al-Ahmad

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Abstract
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Introduction: At this single centre we routinely use multi-modal monitoring of ICP, temperature and brain tissue oxygenation (PbtO2) for non-assessable patients at risk of delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage (aSAH). Of those patients, a proportion of patients with DCI refractory to initial treatments undergo angioplasty (chemical with intra-arterial verapamil or balloon angioplasty).
Methods:
PbtO2 values were recorded from intraparenchymal Raumedic NEUROVENT-PTO probes. Data was recorded continuously and downloaded as second-by-second data. We compared the pre-angioplasty PbtO2 and post-angioplasty PbtO2 median values (over the first 2 hours). We then compared the time that any increase in PbtO2 was sustained for.
Results: Seventeen patients underwent angioplasty, of which 13 had chemical angioplasty and 4 underwent balloon angioplasty. For both interventions there was a significant spike in brain tissue oxygen (at the point of intervention) followed by a median increase in PbtO2 (mmHg) of 5 ± 2mmHg and 12 ± 3 mmHg for chemical and balloon angioplasty respectively. This increase in PbtO2 (mmHg) was sustained for around 4.2 hours and 8.8 hours for chemical and balloon angioplasty respectively.
Conclusion: In this study, balloon angioplasty demonstrated greater and more sustained increase in brain tissue oxygen in patients with refractory vasospasm. A larger prospective study is planned to further investigate this finding.
Introduction: At this single centre we routinely use multi-modal monitoring of ICP, temperature and brain tissue oxygenation (PbtO2) for non-assessable patients at risk of delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage (aSAH). Of those patients, a proportion of patients with DCI refractory to initial treatments undergo angioplasty (chemical with intra-arterial verapamil or balloon angioplasty).
Methods:
PbtO2 values were recorded from intraparenchymal Raumedic NEUROVENT-PTO probes. Data was recorded continuously and downloaded as second-by-second data. We compared the pre-angioplasty PbtO2 and post-angioplasty PbtO2 median values (over the first 2 hours). We then compared the time that any increase in PbtO2 was sustained for.
Results: Seventeen patients underwent angioplasty, of which 13 had chemical angioplasty and 4 underwent balloon angioplasty. For both interventions there was a significant spike in brain tissue oxygen (at the point of intervention) followed by a median increase in PbtO2 (mmHg) of 5 ± 2mmHg and 12 ± 3 mmHg for chemical and balloon angioplasty respectively. This increase in PbtO2 (mmHg) was sustained for around 4.2 hours and 8.8 hours for chemical and balloon angioplasty respectively.
Conclusion: In this study, balloon angioplasty demonstrated greater and more sustained increase in brain tissue oxygen in patients with refractory vasospasm. A larger prospective study is planned to further investigate this finding.
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