Abstract
BackgroundThe use of self-expanding stents to treat post-hemorrhagic cerebral vasospasm was recently described. We sought to determine the clinical efficacy of the Cascade device to treat delayed cerebral vasospasm (DCV). We performed benchside tests to determine the chronic outward force exerted by the Cascade in comparison to the Solitaire.MethodsThe chronic outward force (COF) of the Cascade M agile and Cascade L Agile was tested with equivalent tests of the Solitaire 4x20mm. Further tests to determine the forces generated in pre-formed tubes of 1.5–6 mm were performed using both fully and partially unsheathed Cascades.A retrospective review to identify all patients with aSAH and DCV treated with a Cascade device between January 2020 and July 2021. We recorded the treatment arterial vessel diameters and hemorrhagic or ischemic complications.ResultsIn vitro the Cascade generated greater radial force than the Solitaire. The force generated by the Cascade M Agile at 1.5 mm was approximately 64% higher than the Solitaire 6x40mm and approximately 350% higher than the Solitaire 4x20mm.4 patients with DCV were identified all of whom were treated with a cascade device. In all cases there was a significant improvement in the diameter of the vasospastic vessels treated with an average diameter increase of approximately 300%. There were no complications from the Cascade. Delayed CT angiography showed persistent dilatation of the segments treated with the Cascade at 24 h.ConclusionThe Cascade is a safe and effective device when used to treat DCV secondary to aSAH. Larger studies are required to validate our initial results.
Highlights
Delayed cerebral vasospasm is an important cause of delayed neurological deterioration in patients with aneurysmal subarachnoid haemorrhage (Kassell et al, 1990; Kassell et al, 1985)
During clipping the aneurysm re-ruptured necessitating occlusion of the Internal Carotid Artery (ICA) for haemorrhage control that resulted in right Middle Cerebral Artery (MCA) infarction and consequent hemicraniectomy
The force generated by the Cascade M Agile at 1.5 mm was approximately 64% higher than the Solitaire 6x40mm and approximately 350% higher than the Solitaire 4x20mm
Summary
Delayed cerebral vasospasm is an important cause of delayed neurological deterioration in patients with aneurysmal subarachnoid haemorrhage (aSAH) (Kassell et al, 1990; Kassell et al, 1985). Hypertension is widely used a recent randomised controlled trial (RCT) showed an increase in side effects and no long-term improvement clinically (Gathier et al, 2018). Stent-retrievers and stent like devices have been used to successfully treat cerebral vasospasm (Bhogal et al, 2017a; Bhogal et al, 2017b; Kwon et al, 2019; Badger et al, 2020; Su et al, 2020). The use of self-expanding stents to treat post-hemorrhagic cerebral vasospasm was recently described. We sought to determine the clinical efficacy of the Cascade device to treat delayed cerebral vasospasm (DCV).
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