[The effect of PTA on cerebral vessels in experimental vasospasm: a histopathological study]

Although the percutaneous transluminal angioplasty (PTA) is an useful procedure for the treatment of symptomatic vasospasm after subarachnoid hemorrhage, the morphological changes in spastic intracranial vessels after PTA are not yet clear. The purpose of this study was to evaluate the effects of PTA angiographically and histologically. Chronic cerebral vasospasm was induced by producing a blood clot in the subarachnoid space around the top of internal carotid siphon in Japanese monkey. After angiographic recognition of vasospasm, PTA was carried out with silicone microballoon at 1 atmosphere, 3 times for 10 seconds. Angiography after PTA disclosed significant dilatation at the site of PTA, without any significant dilatation of distal spastic vessels. Papaverine hydrochloride was then infused intra-arterially, which resulted in significant dilatation of distal spastic vessels. Upon histological examination, deformation and some denudation of endothelial cells were noted in the intimal layer. At the site of denudation, attachment of platelets was observed despite generalized heparinization. Internal elastic lamina and the media were also stretched and myocytes were deformed and arranged irregularly. These changes were not uniform all over the vascular walls. We conclude that the prolonged effect of PTA may be caused by mechanical damage of endothelial cells and myocytes, and the nonuniformity of histological changes in vascular wall may be a leading cause of its rupture during PTA.