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  • Distal cerebral vasospasm treatment following aneurysmal subarachnoid hemorrhage using the Comaneci device: technical feasibility and single-center preliminary results

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Hemorrhagic stroke
Case series
Distal cerebral vasospasm treatment following aneurysmal subarachnoid hemorrhage using the Comaneci device: technical feasibility and single-center preliminary results
  1. Louis Thiery1,
  2. Xavier Carle1,
  3. Benoit Testud1,2,3,
  4. Gregoire Boulouis4,
  5. Paul Habert5,6,7,
  6. Farouk Tradi5,6,7,
  7. Anthony Reyre1,
  8. Pierre Lehmann1,
  9. Philippe Dory-Lautrec1,
  10. Jan-Patrick Stellmann1,2,3,
  11. Nadine Girard1,
  12. Herve Brunel1,
  13. Jean-Francois Hak1,6,7
  1. 1 Department of Neuroradiology, APHM La Timone, Marseille, France
  2. 2 CEMEREM, Aix Marseille University, Marseille, France
  3. 3 CNRS, CRMBM, Aix Marseille University, Marseille, France
  4. 4 Department of Neuroradiology, CHRU Tours, Tours, France
  5. 5 Department of Medical Imaging, APHM La Timone, Marseille, France
  6. 6 LIIE, Aix Marseille University, Marseille, France
  7. 7 CERIMED, Aix Marseille University, Marseille, France
  1. Correspondence to Dr Louis Thiery, Bouches du Rhônes, CHU Timone, Marseille13005, Provence-Alpes-Côte d'Azur, France; louisthiery{at}hotmail.fr

Abstract

Background 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.

Methods 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.

Results 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 (κw) 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 (κw 0.98, 95% CI 0.88 to 1).

Conclusion 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.

  • Angioplasty
  • Complication
  • Hemorrhage
  • Intervention
  • Material

http://dx.doi.org/10.1136/neurintsurg-2022-018699

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    Footnotes

    • Twitter @LouisT, @gboulouis

    • Contributors LT, XC, J-FH were responsible for the conception of the study. LT, XC, BT, GB, PH, FT, AR, PL, PD-L, J-PS, NG, HB, J-FH collected the data, had full access to data and take responsibility for the accuracy of the data analysis. LT, XC, J-FH drafted the initial version of the manuscript. All authors, contributed to data acquisition, analysis, and interpretation, and revised and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests XC and J-FH are consultants for educational work with Rapid Medical.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.