LAUSR

Firstly, it’s still controversial whether balloon angioplasty for refractory vasospasm achieves better outcomes compared with the control. Patel et al conducted self-comparison before and after balloon angioplasty to identify outcome improvement. Without a control group and natural history of the disease, we wonder to what extent the improved outcome would be attributed to the noncompliant balloon angioplasty. Besides, Miley et al have already compared the effects of compliant and noncompliant balloon angioplasty on vasospasm, finding no difference in preventing angiographic recurrence. Additionally, it seemed more rational to compare balloon angioplasty with intensive medical treatment like barbiturate coma in patients with refractory vasospasm, as an unbiased control. After all, balloon angioplasty is applied as not only “rescue” therapy but also an alternative choice for patients with intolerance to hemodynamic change of medical treatment. Kimball et al summarized articles regarding endovascular intervention and suggested it as indicated in the event of failed medical management or concern for medical complications. Among the studies comparing effects between balloon angioplasty and conventional medical treatment, none have reached agreement.