1217. Stent Retrievers as a Novel Treatment Tool for Refractory Cerebral Vasospasm

Authors: YouRong Sophie Su, MD; Mario Zanaty, MD; Muhammad Ali, MD; Neda Sedora-Roman, MD; Bryan Pukenas, MD; Christopher Favilla, MD; David Hasan, MD; David Kung, MD (Philadelphia, PA)

Introduction: Cerebral vasospasm commonly contributes to morbidity in patients who survive aneurysmal subarachnoid hemorrhage. When vasospasm becomes refractory to medical management, endovascular treatment options include intraarterial (IA) vasodilator injections and/or balloon angioplasty. However, IA vasodilators often provide limited angiographic improvements and can cause secondary systemic hypotension. Limitations of balloon angioplasty include restricted use to proximal vessels, risk of rupture with balloon inflation, and temporary vessel occlusion. Methods: We report our initial experience on the use of stent retrievers for five cases of refractory vasospasm. After injecting IA nicardipine and noting minimal angiographic improvement, we deployed the stent retriever for two minutes before the stent was re-sheathed. Results: We show safe and successful angiographic resolution of vasospasm in all cases. Four patients had refractory vasospasm of the proximal M1 and A1 branches; one patient had spasm of the distal basilar and proximal P1 arteries. Stent deployment in the proximal vessels improved narrowing significantly, as deemed by two neurointerventionalists. There were no procedural complications. Conclusion: Stent retrievers have several benefits over balloon angioplasty for treatment of vasospasm. Stent retrievers are non-occlusive, conform easily to the curvature of the vessel, and have a known, safe opening force that prevents vessel rupture. In contrast to balloon angioplasty, stent retrievers have limited surface interface with the lumen, theoretically resulting in less endothelial injury. Lastly, most endovascular surgeons have more technical experience with stent retrievers given its widespread use in mechanical thrombectomy. In summary, stent retrievers can be used as a facile, safe, and effective endovascular treatment and should be considered as one of the emerging therapies for refractory cerebral vasospasm.