Novel Treatment of Cerebral Vasospasm Using Solitaire Stent Retriever−Assisted Angioplasty: Case Series

• Published in: World neurosurgery 2020-03, Vol.135, p.e657-e663
• Main Authors: Su, YouRong S., Ali, Muhammad S., Pukenas, Bryan A., Favilla, Christopher G, Zanaty, Mario, Hasan, David M., Kung, David K.
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon - methods; Cerebral vasospasm; Delayed cerebral ischemia; Device Removal - instrumentation; Device Removal - methods; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Endovascular treatment; Female; Humans; Male; Middle Aged; Stent-assisted angioplasty; Stents; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Treatment Outcome; Vasospasm, Intracranial - etiology; Vasospasm, Intracranial - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.12.097

Endovascular procedures such as intraarterial (IA) vasodilator injection and balloon angioplasty are used to treat medically refractory cerebral vasospasm. The effects of IA therapy may be short lived and thus require multiple treatments. Balloon angioplasty also has limitations including transient occlusion of the spastic blood vessel, possible endothelial injury, and limited access to proximal vessels. We aim to demonstrate a novel technique using a stent retriever for the management of medically refractory vasospasm, especially in distal vessels. Compared with balloon angioplasty, stent retrievers provide a passive, self-limiting expansion of blood vessels. Other benefits over balloon angioplasty include 1) ability to simultaneously inject IA vasodilators, 2) limited contact and damage to vessel wall, 3) nonocclusive expansion, and 4) technical ease. Fourteen blood vessels from 6 patients with symptomatic vasospasm after subarachnoid hemorrhage were identified. We injected 5 mg of IA vasodilator medication into the vasospastic segments without radiographic improvement in vessel diameter and blood flow. The stent retriever was deployed for 2–5 minutes in each vasospastic segment. Distal anterior and posterior circulation segments were easily accessible with the stent retriever system. It resulted in improved vessel diameter and blood flow with subsequent improvement in neurologic examination. All patients demonstrated radiographic resolution of vasospasm. No procedural-related complications were noted. We demonstrate the safety and efficacy of a novel technique for the treatment of medically refractory cerebral vasospasm using stent retriever angioplasty in distal vessels. Stent angioplasty can be used as an additional tool in the management of subarachnoid hemorrhage−induced cerebral vasospasm.