EP04* Efficacy and safety in the use of stent-retrievers for treatment of cerebral vasospasms after subarachnoid hemorrhage

Abstract

IntroductionCerebral vasospasms are an important cause of considerable morbidity and mortality after subarachnoid hemorrhage (SAH). In addition to conservative therapy, endovascular spasmolysis can play an important role in the management of this disease. Still, optimal management remains controversial. Stent-retrievers may provide an alternative and additional technique for the treatment of cerebral vasospasms.1Aim of StudyTo investigate the feasibility and safety of mechanical spasmolysis with different stent-retrievers.MethodsWe retrospectively analyzed all patients with vasospasms after SAH that were treated with percutaneous spasmolysis using self-expanding and adjustable stent-retrievers and remodeling devices in addition to conventional vasospasm therapy.Results21 vessel-segments with vasospasms in 12 patients were included. Spasmolysis with stent-retrievers was conducted in proximal and distal vessel segments without complications. In 42.9% a good effect, in 52.4% a medium effect and in only one case (4.8%) a poor angiographic effect was achieved, respectively. Spasmolysis was more effective in distal vessel segments compared to proximal (reduction of stenosis 56.6% vs. 26.7%, p<0.05) and more effective with 3 mm compared to 4 mm stent-retrievers (43.6% vs. 25.8%, p=0.059). 71.4% of patients had a favorable outcome (mRS 0–1) at long-term FU (77–226d).ConclusionStent-retrievers are frequently used in interventional stroke therapy and may represent a safe and effective treatment option for intracranial spasmolysis after SAH, especially for the more distal vessel-segments. Compared to conventional balloon-PTA, this method seems promising by its ease of use, low risk of rupture and retained blood flow during dilatation, however further improvement of the radial force is recommended.ReferenceBhogal P, Loh Y, Brouwer P, et al. Treatment of cerebral vasospasm with self-expandable retrievable stents: proof of concept. J Neurointerv Surg 2017;9:52–59. doi:10.1136/neurintsurg-2016–012546DisclosureFundingNo funding was received for this research. Johannes Hensler: Personal fees from consultant activity for Balt, outside the submitted work. Wodarg F: Personal fees from consultant activity for Microvention, personal fees from consultant activity for Acandis, personal fees from consultant activity for Cerus Endovascular, personal fees from consultant activity for Cerenovus, personal fees from consultant activity for Balt, outside the submitted work. Jawid Madjidyar: none Sönke Peters: none Gesa Cohrs: none Olav Jansen: Personal fees from consultant activity for STRYKER, personal fees from consultant activity for Medtronic, personal fees from consultant activity for Covidien, outside the submitted work. Naomi Larsen: none