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