Clinical Neuroradiology

, Volume 29, Issue 4, pp 751–761 | Cite as

Stent-Retriever Angioplasty for Recurrent Post-Subarachnoid Hemorrhagic Vasospasm – A Single Center Experience with Long-Term Follow-Up

  • Hyon-Jo Kwon
  • Jeong-Wook LimEmail author
  • Hyeon-Song Koh
  • BumSoo Park
  • Seung-Won Choi
  • Seon-Hwan Kim
  • Jin-Young Youm
  • Shi-Hun Song
Original Article



We report our experience of using stent-retrievers for recurrent cerebral vasospasm (CVS) secondary to aneurysmal subarachnoid hemorrhage (aSAH).


We performed a retrospective review of our prospectively maintained institutional database to identify all patients with recurrent CVS and treated with stent-retrievers between April 2011 and May 2017. All patients were initially treated with intra-arterial (IA) vasodilators and were subsequently re-treated with stent-retrievers if they developed recurrent vasospasm. Patients were categorized into two groups, those in which IA vasodilators were given again prior to the stent-retriever deployment (VD-first) and those in which the stent-retriever was deployed first and IA vasodilators were given subsequently (SR-first).


We identified 12 patients (7 females, mean age 54.9 years), 5 in the VD-first and 7 in the SR-first cohorts. Stent-retriever lumen dilatation was attempted in 53 segments (VD-first 14, SR-first 39). Stent-retriever deployment was technically feasible in all cases. Vasodilation occurred in 71.4% (10/14 segments) in the VD-first group and 82.1% (32/39 segments) in SR-first group. Additional treatment was required in 5 segments. There was no recurrent vasospasm in the SR-first group; however, 3 patients (60%) in the VD-first group showed recurrent vasospasm. No angiographical abnormality was found at long-term follow-up (7 patients, mean 29.1 months).


The use of stent-retrievers to treat cerebral vasospasm is technically feasible and can cause long-term vasodilatation; however, this effect is maximized if stent-retrievers are used prior to infusion of IA vasodilators.


SAH Angioplasty Recurrent vasospasm Stentriever 





Transluminal balloon angioplasty



This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical guidelines

Conflict of interest

H.-J. Kwon, J.-W. Lim, H.-S. Koh, B. Park, S.-W. Choi, S.-H. Kim, J.-Y. Youm and S.-H. Song declare that they have no competing interests.

Ethical standards

Approval by the institutional review board at our institute and acquisition of informed consent from the patient and/or their families prior to the procedures were completed before this study.


  1. 1.
    Mortimer AM, Steinfort B, Faulder K, Bradford C, Finfer S, Assaad N, Harrington T. The detrimental clinical impact of severe angiographic vasospasm may be diminished by maximal medical therapy and intensive endovascular treatment. J Neurointerv Surg. 2015;7:881–7.CrossRefGoogle Scholar
  2. 2.
    Abruzzo T, Moran C, Blackham KA, Eskey CJ, Lev R, Meyers P, Narayanan S, Prestigiacomo CJ. Invasive interventional management of post-hemorrhagic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurointerv Surg. 2012;4:169–77.CrossRefGoogle Scholar
  3. 3.
    Bulsara KR, Günel M, Amin-Hanjani S, Chen PR, Connolly ES, Friedlander RM. Results of a national cerebrovascular neurosurgery survey on the management of cerebral vasospasm/delayed cerebral ischemia. J Neurointerv Surg. 2015;7:408–11.CrossRefGoogle Scholar
  4. 4.
    Sokolowski JD, Chen CJ, Ding D, Buell TJ, Raper DM, Ironside N, Taylor DG, Starke RM, Liu K. Endovascular treatment for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: predictors of outcome and retreatment. J Neurointerv Surg. 2018;10:367–74.CrossRefGoogle Scholar
  5. 5.
    Hoh BL, Ogilvy CS. Endovascular treatment of cerebral vasospasm: transluminal balloon angioplasty, intra-arterial papaverine, and intra-arterial nicardipine. Neurosurg Clin N Am. 2005;16:501–16.CrossRefGoogle Scholar
  6. 6.
    Heit JJ, Choudhri O, Marks MP, Dodd RL, Do HM. Cerebral angioplasty using the Scepter XC dual lumen balloon for the treatment of vasospasm following intracranial aneurysm rupture. J Neurointerv Surg. 2015;7:56–61.CrossRefGoogle Scholar
  7. 7.
    Venkatraman A, Khawaja AM, Gupta S, Hardas S, Deveikis JP, Harrigan MR, Kumar G. Intra-arterial vasodilators for vasospasm following aneurysmal subarachnoid hemorrhage: a meta-analysis. J Neurointerv Surg. 2018;10:380–7.CrossRefGoogle Scholar
  8. 8.
    Rasmussen R, Bache S, Stavngaard T, Skjøth-Rasmussen J, Romner B. Real-time changes in brain tissue oxygen during endovascular treatment of cerebral vasospasm. Acta Neurochir Suppl. 2015;120:183–6.PubMedGoogle Scholar
  9. 9.
    Zwienenberg-Lee M, Hartman J, Rudisill N, Madden LK, Smith K, Eskridge J, Newell D, Verweij B, Bullock MR, Baker A, Coplin W, Mericle R, Dai J, Rocke D, Muizelaar JP; Balloon Prophylaxis for Aneurysmal Vasospasm (BPAV) Study Group. Effect of prophylactic transluminal balloon angioplasty on cerebral vasospasm and outcome in patients with Fisher grade III subarachnoid hemorrhage: results of a phase II multicenter, randomized, clinical trial. Stroke. 2008;39:1759–65.CrossRefGoogle Scholar
  10. 10.
    Bhogal P, Paraskevopoulos D, Makalanda HL. The use of a stent-retriever to cause mechanical dilatation of a vasospasm secondary to iatrogenic subarachnoid haemorrhage. Interv Neuroradiol. 2017;23:330–5.CrossRefGoogle Scholar
  11. 11.
    Bhogal P, Loh Y, Brouwer P, Andersson T, Söderman M. Treatment of cerebral vasospasm with self-expandable retrievable stents: proof of concept. J Neurointerv Surg. 2017;9:52–9.CrossRefGoogle Scholar
  12. 12.
    Rosenberg N, Lazzaro MA, Lopes DK, Prabhakaran S. High-dose intra-arterial nicardipine results in hypotension following vasospasm treatment in subarachnoid hemorrhage. Neurocrit Care. 2011;15:400–4.CrossRefGoogle Scholar
  13. 13.
    Cross DT 3rd, Moran CJ, Angtuaco EE, Milburn JM, Diringer MN, Dacey RG Jr.. Intracranial pressure monitoring during intra-arterial papaverine infusion for cerebral vasospasm. AJNR Am J Neuroradiol. 1998;19:1319–23.PubMedGoogle Scholar
  14. 14.
    Fischell TA, Grant G, Johnson DE. Determinants of smooth muscle injury during balloon angioplasty. Circulation. 1990;82:2170–84.CrossRefGoogle Scholar
  15. 15.
    Macdonald RL, Zhang J, Han H. Angioplasty reduces pharmacologically mediated vasoconstriction in rabbit carotid arteries with and without vasospasm. Stroke. 1995;26:1053–9. discussion 1059–60.CrossRefGoogle Scholar
  16. 16.
    Machi P, Jourdan F, Ambard D, Reynaud C, Lobotesis K, Sanchez M, Bonafé A, Costalat V. Experimental evaluation of stent retrievers’ mechanical properties and effectiveness. J Neurointerv Surg. 2017;9:257–63.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hyon-Jo Kwon
    • 1
  • Jeong-Wook Lim
    • 1
    Email author
  • Hyeon-Song Koh
    • 1
  • BumSoo Park
    • 1
  • Seung-Won Choi
    • 1
  • Seon-Hwan Kim
    • 1
  • Jin-Young Youm
    • 1
  • Shi-Hun Song
    • 1
  1. 1.Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular CenterChungnam National University Medical School and HospitalDaejeonKorea (Republic of)

Personalised recommendations