Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
J Clin Neurosci. 2024 Oct;128:110784. doi: 10.1016/j.jocn.2024.110784. Epub 2024 Aug 13.
Cerebral vasospasm is a leading source of delayed morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Angioplasty may improve vasospasm, while optimal target and device selection remains controversial. This study aimed to identify features and devices associated with sustained efficacy.
We identified consecutive patients who underwent angioplasty for aSAH vasospasm. The primary outcome was a composite of adequate angioplasty (residual narrowing < 50 %) without complications. Secondary outcomes included rates of refractory/recurrent vasospasm and sustained improvement at follow-up. Associated features were identified through multivariable analysis. Outcomes were compared between balloon and Comaneci/stentriever in a propensity-score-matched cohort.
A total of 149 vasospastic segments underwent angioplasty: 61.7 % in the proximal anterior circulation (ICA, M1, A1), 20.1 % in distal segments (A2 and M2) and 18.1 % in the posterior circulation. Adequate angioplasty was achieved without complication in 83.2 % of vessels, with a sustainable effect in 84.3 % at follow-up. Refractory/recurrent vasospasm was observed in 17.4 %, yielding a 10.1 % retreatment rate. Notably, only 35.3 % of vessels undergoing inadequate angioplasty demonstrated improvement at follow-up. Angioplasty targeting distal MCA (adjusted OR, 0.10) or BA-V4 (aOR, 0.10), and inadequate angioplasty (aOR, 0.03) were unfavorable predictors for sustained improvement. Efficacy outcomes were similar between balloon and Comaneci/stentriever in a matched subgroup analysis.
Angioplasty, when achieving residual narrowing < 50 %, demonstrated sustained improvement for vasospasm. Novel devices may exhibit comparable efficacy to balloon angioplasty for selected segments.
脑动脉痉挛是蛛网膜下腔出血（aSAH）后迟发性发病率和死亡率的主要原因。血管成形术可能改善血管痉挛，而最佳的目标和设备选择仍存在争议。本研究旨在确定与持续疗效相关的特征和设备。
我们确定了连续接受血管成形术治疗 aSAH 血管痉挛的患者。主要结局是无并发症的充分血管成形术（残余狭窄<50%）的复合结局。次要结局包括难治性/复发性血管痉挛的发生率和随访时的持续改善。通过多变量分析确定相关特征。在倾向评分匹配的队列中比较球囊与 Comaneci/支架旋切器的结果。
共有 149 个血管痉挛段接受了血管成形术：前循环近端（ICA、M1、A1）占 61.7%，远端节段（A2 和 M2）占 20.1%，后循环占 18.1%。83.2%的血管在无并发症的情况下实现了充分的血管成形术，84.3%在随访时具有可持续的效果。难治性/复发性血管痉挛的发生率为 17.4%，再治疗率为 10.1%。值得注意的是，只有 35.3%的血管成形术不充分的血管在随访时显示出改善。血管成形术针对远端 MCA（调整 OR，0.10）或 BA-V4（aOR，0.10）以及血管成形术不充分（aOR，0.03）是持续改善的不利预测因素。在匹配的亚组分析中，球囊和 Comaneci/支架旋切器的疗效结果相似。
当残余狭窄<50%时，血管成形术显示出对血管痉挛的持续改善。对于选定的节段，新型设备可能与球囊血管成形术具有相似的疗效。
