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COManeci MechANical Dilation for vasospasm (COMMAND): multicenter experience
  1. Mohamed M Salem1,
  2. Jane Khalife2,
  3. Sohum Desai3,
  4. Vera Sharashidze4,
  5. Clint Badger2,
  6. Anna L Kuhn5,
  7. Andre Monteiro6,
  8. Hisham Salahuddin7,
  9. Adnan H Siddiqui6,
  10. Jasmeet Singh5,
  11. Elad I Levy6,
  12. Michael Lang8,
  13. Ramesh Grandhi9,
  14. Ajith J Thomas2,
  15. Li-Mei Lin10,
  16. Omar Tanweer11,
  17. Jan-Karl Burkhardt1,
  18. Ajit S Puri5,
  19. Bradley A Gross8,
  20. Erez Nossek4,
  21. Ameer E Hassan3,
  22. Hamza A Shaikh2,
  23. Brian T Jankowitz1
  1. 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
  2. 2Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
  3. 3Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
  4. 4Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
  5. 5Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
  6. 6Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  7. 7Department of Neurology, Antelope Valley Medical Center, Lancaster, California, USA
  8. 8Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  9. 9Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
  10. 10Carondelet Neurological Institute, Carondelet Health Network, Tucson, Arizona, USA
  11. 11Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Brian T Jankowitz, Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA; brian.jankowitz{at}pennmedicine.upenn.edu

Abstract

Background We report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm.

Methods 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.

Results 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).

Conclusions The Comaneci device provides a complementary strategy for treatment of refractory vasospasm with reasonable efficacy/favorable safety. Future prospective trials are warranted.

  • Subarachnoid
  • Hemorrhage

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Footnotes

  • Twitter @MMSalemMD, @sohum_md, @andremonteiromd, @h15ham, @drlimeilin, @AjitSPuri1, @Enossek

  • Contributors MMS and BTJ were the lead investigators. They were involved in the design of the study, acquisition and analysis of data, drafting and revising the manuscript for intellectual content, and final approval of the version to be published. JK, SD, VS, CB, ALK, AM, HS, AHS, JS, EIL, ML, RG, AJT, LML, OT, JKB, ASP, BAG, EN, AEH, and HAS were coinvestigators and were responsible for acquisition of the data, drafting and revising the manuscript for intellectual content, and final approval of the version to be published. All authors agree to be accountable for all aspects of the current work, including its accuracy and integrity, and sound investigative methodology.BTJ is the guarantor of the work and accepts full responsibility for the conduction of the study.

  • 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 None declared.

  • 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.