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. 2024 Nov 15:15910199241293173.
doi: 10.1177/15910199241293173. Online ahead of print.

Balloon angioplasty for cerebral vasospasm in preschool children

Zeferino Demartini Jr  1   2 , Flavio Requejo  3 , Renato Fedato Beraldo  2 , Adriano Keijiro Maeda  2 , Alexandre Mello Savoldi  2 , Adriane Cardoso-Demartini  4
Affiliations

Balloon angioplasty for cerebral vasospasm in preschool children

Zeferino Demartini Jr et al. Interv Neuroradiol. .

Abstract

Background: Subarachnoid hemorrhage evolving with cerebral vasospasm and delayed cerebral ischemia may increase morbidity and mortality. Treating vasospasm with balloon percutaneous angioplasty (PTA) in adults is well known, but data in preschool children are scarce. In addition, the smaller diameters and fragility of the vessels in childhood might lead to serious complications. This study presents two cases of cerebral vasospasm in preschool children treated with balloon PTA. Therefore, it may contribute to a better understanding of the role of that technique as an effective treatment modality in this population.

Methods: Balloon PTA was performed in two children (3 and 4 year-old) with aneurysmal subarachnoid hemorrhage and delayed cerebral ischemia.

Results: The procedures were uneventful, and both patients survived without complications or new infarction.

Conclusions: Balloon PTA for proximal vasospasm may improve clinical outcomes in selected pediatric patients. Further studies are needed to clarify the best candidates, materials, and techniques.

Keywords: Balloon angioplasty; child; intracranial vasospasm; subarachnoid hemorrhage.

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Conflict of interest statement

Data availability statementAll data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author. Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A 3-year-old boy presented with vomiting evolving to coma; the CT scan (a) shows hemorrhage and a posterior fossa mass, while digital angiography (b) shows a giant vertebrobasilar aneurysm junction (c); the parent vessel occlusion with coils (d) achieves excellent clinical result; however, after clinical worsening 11 days after bleeding, an MRI evidences bilateral cerebral ischemia (e) due to carotid arteries vasospasm (f); endovascular treatment with balloon angioplasty (g) improves the arterial diameter (h), and the 1-year follow-up CT (i) shows good brain recovery. CT: computed tomography; MRI: magnetic resonance imaging.
Figure 2.
Figure 2.
A 5-year-old boy presented with sudden headache and vomiting; CT scan (a) shows temporal hematoma with ventricular hemorrhage; digital angiography (b,c) shows a distal 2 mm aneurysm in the left posterior cerebral artery (arrows), which was occluded with coils (d); MRI shows cerebral ischemia 7 days after bleeding (e) due to symptomatic left carotid artery vasospasm (f); endovascular treatment with balloon angioplasty (g) achieves good result (h); and the 6-month follow-up CT (i) shows left cerebral hemisphere atrophy. CT: computed tomography; MRI: magnetic resonance imaging.
See this image and copyright information in PMC

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