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

Publication ,  Conference
Su, YS; Ali, MS; Pukenas, BA; Favilla, CG; Zanaty, M; Hasan, DM; Kung, DK
Published in: World Neurosurg
March 2020

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

March 2020

Volume

135

Start / End Page

e657 / e663

Location

United States

Related Subject Headings

  • Vasospasm, Intracranial
  • Treatment Outcome
  • Subarachnoid Hemorrhage
  • Stents
  • Middle Aged
  • Male
  • Humans
  • Female
  • Endovascular Procedures
  • Device Removal
 

Citation

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ICMJE
MLA
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Su, Y. S., Ali, M. S., Pukenas, B. A., Favilla, C. G., Zanaty, M., Hasan, D. M., & Kung, D. K. (2020). Novel Treatment of Cerebral Vasospasm Using Solitaire Stent Retriever-Assisted Angioplasty: Case Series. In World Neurosurg (Vol. 135, pp. e657–e663). United States. https://doi.org/10.1016/j.wneu.2019.12.097
Su, YouRong S., Muhammad S. Ali, Bryan A. Pukenas, Christopher G. Favilla, Mario Zanaty, David M. Hasan, and David K. Kung. “Novel Treatment of Cerebral Vasospasm Using Solitaire Stent Retriever-Assisted Angioplasty: Case Series.” In World Neurosurg, 135:e657–63, 2020. https://doi.org/10.1016/j.wneu.2019.12.097.
Su YS, Ali MS, Pukenas BA, Favilla CG, Zanaty M, Hasan DM, et al. Novel Treatment of Cerebral Vasospasm Using Solitaire Stent Retriever-Assisted Angioplasty: Case Series. In: World Neurosurg. 2020. p. e657–63.
Su, YouRong S., et al. “Novel Treatment of Cerebral Vasospasm Using Solitaire Stent Retriever-Assisted Angioplasty: Case Series.World Neurosurg, vol. 135, 2020, pp. e657–63. Pubmed, doi:10.1016/j.wneu.2019.12.097.
Su YS, Ali MS, Pukenas BA, Favilla CG, Zanaty M, Hasan DM, Kung DK. Novel Treatment of Cerebral Vasospasm Using Solitaire Stent Retriever-Assisted Angioplasty: Case Series. World Neurosurg. 2020. p. e657–e663.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

March 2020

Volume

135

Start / End Page

e657 / e663

Location

United States

Related Subject Headings

  • Vasospasm, Intracranial
  • Treatment Outcome
  • Subarachnoid Hemorrhage
  • Stents
  • Middle Aged
  • Male
  • Humans
  • Female
  • Endovascular Procedures
  • Device Removal