1164. Novel Treatment of Subarachnoid Hemorrhage Induced Vasospasm Using Solitaire Stent Retriever System

Authors: Muhammad Ali, MD; Yourong SU; Mario Zanaty, MD; Kota Kurisu, MD; David Hasan; David Kung (Iowa City, IA)

Introduction: Cerebral vasospasm is a narrowing of angiographically visible cerebral arteries which occurs in 70% of patients. Delayed cerebral ischemia (DCI) is a sequalae of aneurysmal SAH and a major cause of death and disability. Medically refractory patients undergo endovascular procedures including intra-arterial (IA) vasodilator injection and balloon angioplasty. The effects of IA therapy are short lived and require multiple treatments. Limitations of balloon angioplasty include: transient occlusion of already spastic blood vessel, thrombo-embolic events from endothelial and vessel wall injury, vessel rupture and access limited to proximal vessels. Here, we demonstrate a novel technique for the management of medially refractory vasospasm, using Solitaire Stent Retriever system. Methods: We identified 5 patients from our database who underwent stent assisted angioplasty. These patients developed DCI and were taken to the operating room for endovascular treatment. 5mg Verapamil was injected into the vasospastic segments without significant improvement in vessel diameter and blood flow. Solitaire stent retriever system was deployed individually in each vasospastic segment of the vessels, for 5 minutes each. Segments which underwent treatment included: A1, A2, M1, M2, and basilar artery. Results: All patients demonstrated radiographic improvement in the cerebral vasospasm. It resulted in increased vessel diameter and blood flow, and improvement in neurological exam. This technique provides the following benefits over IA and balloon angioplasty: non-occlusive deployment, ability to simultaneously inject IA vasodilators, ability to access distal segments (A2, M2), minimal contact and damage to vessel wall, self-limiting expansion of the stent; minimizing risk of vessel rupture, durable vasodilation and familiarity with using Solitaire system. Conclusion: We demonstrate the safety and efficacy of a novel technique for the treatment of medically refractory cerebral vasospasm using Solitaire stent retriever system. This provides an additional tool in the management of SAH induced cerebral vasospasm.