Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA.
J Neurointerv Surg. 2023 Sep;15(9):864-870. doi: 10.1136/jnis-2022-019272. Epub 2022 Aug 24.
We report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm.
Consecutive patients undergoing Comaneci mechanical dilatation for vasospasm were extracted from prospectively maintained registries in 11 North American centers (2020-2022). Intra-arterial vasodilators (IAV) were allowed, with the Comaneci device utilized after absence of vessel dilation post-infusion. Pre- and post-vasospasm treatment scores were recorded for each segment, with primary radiological outcome of score improvement post-treatment. Primary clinical outcome was safety/device-related complications, with secondary endpoints of functional outcomes at last follow-up.
A total of 129 vessels in 40 patients (median age 52 years; 67.5% females) received mechanical dilation, 109 of which (84.5%) exhibited pre-treatment severe-to-critical vasospasm (ie, score 3/4). Aneurysmal subarachnoid hemorrhage was the most common etiology of vasospasm (85%), with 65% of procedures utilizing Comaneci-17 (92.5% of patients received IAV). The most treated segments were anterior cerebral artery (34.9%) and middle cerebral artery (31%). Significant vasospasm drop (pre-treatment score (3-4) to post-treatment (0-2)) was achieved in 89.9% of vessels (96.1% of vessels experienced ≥1-point drop in score post-treatment). There were no major procedural/post-procedural device-related complications. Primary failure (ie, vessel unresponsive) was encountered in one vessel (1 patient) (1/129; 0.8%) while secondary failure (ie, recurrence in previously treated segment requiring retreatment in another procedure) occurred in 16 vessels (7 patients) (16/129; 12.4%), with median time-to-retreatment of 2 days. Favorable clinical outcome (modified Rankin Scale 0-2) was noted in 51.5% of patients (median follow-up 6 months).
The Comaneci device provides a complementary strategy for treatment of refractory vasospasm with reasonable efficacy/favorable safety. Future prospective trials are warranted.
我们报告了迄今为止最大的多中心经验，即利用 Comaneci 装置进行血管内治疗难治性颅内血管痉挛。
从 11 个北美中心（2020-2022 年）的前瞻性维护登记处提取连续接受 Comaneci 机械扩张治疗血管痉挛的患者。允许使用动脉内血管扩张剂（IAV），在注入后血管无扩张时使用 Comaneci 装置。记录每个节段治疗前后的评分，主要的放射学结果是治疗后评分改善。主要的临床结果是安全性/与器械相关的并发症，次要终点是最后一次随访时的功能结局。
40 名患者的 129 支血管（中位年龄 52 岁；67.5%为女性）接受了机械扩张，其中 109 支（84.5%）存在治疗前严重至临界血管痉挛（即评分 3/4）。蛛网膜下腔出血性动脉瘤是血管痉挛最常见的病因（85%），65%的手术使用 Comaneci-17（92.5%的患者使用 IAV）。治疗最多的节段是大脑前动脉（34.9%）和大脑中动脉（31%）。89.9%的血管（96.1%的血管在治疗后评分至少降低 1 分）实现了显著的血管痉挛缓解（治疗前评分（3-4）到治疗后（0-2））。没有主要的手术/手术后器械相关并发症。1 支血管（1 名患者）（1/129；0.8%）出现单一血管（1 例）（1/129；0.8%）的主要治疗失败（即血管无反应），而 16 支血管（7 名患者）（16/129；12.4%）出现次要治疗失败（即以前治疗的节段复发，需要在另一程序中再次治疗），再次治疗的中位时间为 2 天。51.5%的患者（中位随访 6 个月）获得了良好的临床结局（改良 Rankin 量表 0-2）。
Comaneci 装置为治疗难治性血管痉挛提供了一种补充策略，具有合理的疗效和良好的安全性。未来需要前瞻性试验。
