Guenego Adrien, Salim Hamza Adel, Wang Maud, Heit Jeremy J, Sadeghi Niloufar, Ligot Noémie, Lolli Valentina, Tannouri Fadi, Taccone Fabio Silvio, Lubicz Boris
Interventional Neuroradiology Department Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium.
Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
J Belg Soc Radiol. 2024 Oct 17;108(1):89. doi: 10.5334/jbsr.3714. eCollection 2024.
Cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage (aSAH) may lead to morbidity and mortality. Endovascular mechanical angioplasty may be performed if symptomatic CV is refractory to noninvasive medical management. Compliant and noncompliant balloons and manually adjustable mesh may be used in this indication. We describe our initial experience with the Comaneci (Rapid Medical, Yokneam, Israel) in cerebral vasospasm treatment following aSAH. All patients included in the prospective observational SAVEBRAIN PWI (NCT05276934 on clinicaltrial.gov) study who underwent cerebral angioplasty using the Comaneci device for the treatment of medically refractory and symptomatic CV after aSAH were identified. Patient demographic information, procedural details, and outcomes were obtained from electronic medical records. Between February 2022 and June 2023, seven consecutive patients underwent CV treatment with the Comaneci. Angioplasty of 37 arterial segments (supraclinoid internal carotid artery, A1, A2, and A3 segments of the anterior cerebral artery and M1 and M2 segments of the middle cerebral artery) was attempted, and 35/37 (95%) were performed. The vessel diameter improved significantly following angioplasty (+64%), while brain hypoperfusion decreased (-45% of the mean ). There was no long-term clinical complication, and 6% per-procedural complications occurred. The Comaneci is effective in the treatment of cerebral vasospasm following aSAH, bringing a new device in the armamentarium of the neurointerventionalist to perform intracranial angioplasty.
动脉瘤性蛛网膜下腔出血（aSAH）后的脑血管痉挛（CV）可能导致发病和死亡。如果有症状的CV对非侵入性药物治疗无效，可进行血管内机械血管成形术。在此适应症中可使用顺应性和非顺应性球囊以及手动可调网。我们描述了我们在使用Comaneci（Rapid Medical，以色列约克奈姆）治疗aSAH后脑血管痉挛方面的初步经验。在prospective observational SAVEBRAIN PWI（clinicaltrial.gov上的NCT05276934）研究中，确定了所有接受使用Comaneci设备进行脑血管成形术以治疗aSAH后药物难治性和有症状CV的患者。从电子病历中获取患者人口统计学信息、手术细节和结果。在2022年2月至2023年6月期间，连续7名患者接受了Comaneci治疗CV。尝试对37个动脉节段（床突上段颈内动脉、大脑前动脉的A1、A2和A3节段以及大脑中动脉的M1和M2节段）进行血管成形术，其中35/37（95%）成功完成。血管成形术后血管直径显著改善（+64%），而脑灌注不足减少（平均减少45%）。没有长期临床并发症，术中并发症发生率为6%。Comaneci在治疗aSAH后脑血管痉挛方面有效，为神经介入医生进行颅内血管成形术提供了一种新设备。
