Thiery Louis, Carle Xavier, Testud Benoit, Boulouis Gregoire, Habert Paul, Tradi Farouk, Reyre Anthony, Lehmann Pierre, Dory-Lautrec Philippe, Stellmann Jan-Patrick, Girard Nadine, Brunel Herve, Hak Jean-Francois
Department of Neuroradiology, APHM La Timone, Marseille, France
Department of Neuroradiology, APHM La Timone, Marseille, France.
J Neurointerv Surg. 2023 Apr;15(4):325-329. doi: 10.1136/neurintsurg-2022-018699. Epub 2022 May 18.
Balloon-assisted mechanical angioplasty for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) has a number of limitations, including transient occlusion of the spastic blood vessel. Comaneci is an FDA-approved device for temporary coil embolization assistance which has recently also been approved for the treatment of distal symptomatic refractory vasospasm. We aimed to report the feasibility, efficacy and safety of our experience with Comaneci angioplasty for refractory distal vasospasm (up to the second segment of the cerebral arteries) following aSAH.
This is a retrospective analysis of a prospective series of 18 patients included between April 2019 and June 2021 with aSAH and symptomatic vasospasm refractory to medical therapy, who were treated using Comaneci-17-asssisted mechanical distal angioplasty. Immediate angiographic results, procedure-related complications, and clinical outcomes were assessed. Inter-rater reliability of the scores was determined using the intraclass correlation coefficient.
Comaneci-assisted distal angioplasty was performed in 18 patients, corresponding to 31 target arteries. All distal anterior segments were easily accessible with the Comaneci-17 device. Vasospasm improvement after Comaneci mechanical angioplasty was seen in 22 distal arteries (71%) (weighted Cohen's kappa (κ) 0.73, 95% CI 0.69 to 0.93). Vasospasm recurrence occurred in three patients (16.67%) and delayed cerebral infarction in three patients (16.67%), with a mean±SD delay between onset of symptoms and imaging follow-up (MRI/CT) of 32.61±8.93 days (κ 0.98, 95% CI 0.88 to 1).
This initial experience suggests that distal mechanical angioplasty performed with the Comaneci-17 device for refractory vasospasm following aSAH seems to be safe, with good feasibility and efficacy.
球囊辅助机械血管成形术治疗动脉瘤性蛛网膜下腔出血（aSAH）后的脑血管痉挛存在诸多局限性，包括对痉挛血管的短暂闭塞。Comaneci是一种经美国食品药品监督管理局（FDA）批准用于临时线圈栓塞辅助的设备，最近也被批准用于治疗远端症状性难治性血管痉挛。我们旨在报告使用Comaneci血管成形术治疗aSAH后难治性远端血管痉挛（直至脑动脉第二段）的可行性、有效性和安全性。
这是一项对2019年4月至2021年6月期间纳入的18例aSAH且药物治疗无效的症状性血管痉挛患者的前瞻性系列研究的回顾性分析，这些患者接受了Comaneci-17辅助机械远端血管成形术治疗。评估即刻血管造影结果、手术相关并发症和临床结局。使用组内相关系数确定评分者间的可靠性。
18例患者接受了Comaneci辅助远端血管成形术，对应31条靶血管。使用Comaneci-17设备可轻松到达所有远端前段。Comaneci机械血管成形术后，22条远端动脉（71%）的血管痉挛得到改善（加权科恩kappa系数（κ）0.73，95%置信区间0.69至0.93）。3例患者（16.67%）出现血管痉挛复发，3例患者（16.67%）出现延迟性脑梗死，症状出现至影像学随访（MRI/CT）的平均±标准差延迟时间为32.61±8.93天（κ 0.98，95%置信区间0.88至1）。
这一初步经验表明，使用Comaneci-17设备对aSAH后难治性血管痉挛进行远端机械血管成形术似乎是安全的，具有良好的可行性和有效性。
