Possible Contribution of the Aspiration Catheter in Preventing Post-stent Retriever Thrombectomy Subarachnoid Hemorrhage

Nariai, Yasuhiko; Takigawa, Tomohiro; Kawamura, Yosuke; Hyodo, Akio; Suzuki, Kensuke

doi:10.1007/s00062-022-01240-4

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…Also, we found patients treated for anterior circulation target vessel K occlusion to be more likely to experience vasospasm during EVT compared to posterior circulation target vessel occlusion independent of prophylactic treatment with nimodipine. At nearly 30%, the general rate of vasospasm is high in this study compared to the literature [1][2][3][4]. This is probably due to the younger study cohort (patients > 80 years of age are excluded), the varying definition of vasospasm (> 50% concentric stenosis in this study) and a probable underrepresentation in the literature (non-relevant vasospasms might not be reported continuously by neurointerventionalists).…”

Section: Discussionmentioning

confidence: 59%

“…More than 10% of endovascular stroke treatments (EVTs) for acute ischemic stroke are associated with periprocedural complications [1]. Iatrogenic vasospasm is a common complication (3.9-23%) that occurs due to vessel wall irritation during device instrumentation or thrombectomy retrieval maneuvers [2][3][4]. Extracranial vasospasm of the parent vessel arteries occur when placing guide catheters and intracranial vasospasm occurs during stent retriever or contact aspiration placement.…”

Section: Introductionmentioning

confidence: 99%

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Nimodipine as Vasodilator in Guide Catheter Flush to Prevent Vasospasm During Endovascular Stroke Treatment

Sommer,

Jesser,

Nikoubashman

et al. 2024

Clin Neuroradiol

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Purpose The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate the effect of adding nimodipine to the guiding catheter flush (GCF) to prevent vasospasm during EVT. Methods This is a single-center retrospective analysis including patients with EVT (stent-retriever and/or distal aspiration) treated for anterior or posterior circulation intracranial vessel occlusion from January 2018 to June 2023. Exclusion criteria were intracranial or extracranial stenosis, intra-arterial alteplase, patient age over 80 years. Study groups were patients with (nimo+) and without (nimo−) nimodipine in the GCF. They were compared for occurrence of vasospasm as primary endpoint and clinical outcome in univariate analysis. Results 477 patients were included in the analysis (nimo+ n = 94 vs. nimo− n = 383). Nimo+ patients experienced less vasospasm during EVT (e.g. vasospasm in target vessel n (%): nimo− = 113 (29.6) vs. nimo+ = 9 (9.6), p < 0.001; extracranial vasospasm, n (%): nimo− = 68 (17.8) vs. nimo+ = 7 (7.4), p = 0.017). Patients of the two study groups had a comparable clinical outcome (90 day mRS, median (IQR): 3 (1–6) for both groups, p = 0.896). In general, patients with anterior circulation target vessel occlusion (TVO) experienced more vasospasm (anterior circ. TVO 38.7% vs. posterior circ. 7.5%, p = 0.006). Conclusion Prophylactic adding of nimodipine reduces the risk of vasospasm during EVT without affecting the clinical outcome. Patients with anterior circulation TVO experienced more vasospasm compared to posterior circulation TVO.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Nimodipine as Vasodilator in Guide Catheter Flush to Prevent Vasospasm During Endovascular Stroke Treatment

Sommer,

Jesser,

Nikoubashman

et al. 2024

Clin Neuroradiol

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“…1 They include distal embolisation to a new territory (4%-6%), de novo stenosis of target vessels (3.4%), vessel perforation (0.6%-4.9%), dissection (0.6%-3.9%), groin haematoma (2%-10%) and vasospasm (3.9%-23%). [2][3][4] Iatrogenic vasospasm is a common complication that occurs due to the vessel wall irritation during probing or thrombectomy manoeuvres. Extracranial vasospasms of target vessel arteries occur when placing guiding catheters and intracranial vasospasms occur during stent retriever or contact aspiration instrumentation.…”

Section: Introductionmentioning

confidence: 99%

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Jesser,

Nguyen,

Dmytriw

et al. 2023

Stroke Vasc Neurol

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Background and aimThe clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT.MethodsWe conducted an anonymous international online survey (4 April 2023 to 15 May 2023) addressing treatment standards of neurointerventionalists (NIs) practising EVT. Several illustrative cases of patients with vasospasm during EVT were shown. Two study groups were compared according to the NI’s opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis.ResultsIn total, 534 NI from 56 countries responded, of whom 51.5% had performed >200 EVT. Vasospasm was considered a complication potentially influencing the patient’s outcome by 52.6% (group 1) whereas 47.4% did not (group 2). Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely (43.7% vs 33.9%, p=0.033) and more often treated severe large-vessel vasospasm with vasodilators (75.3% vs 55.9%; p<0.001), as well as extracranial vasospasm (61.4% vs 36.5%, p<0.001) and intracranial medium-vessel vasospasm (27.1% vs 11.2%, p<0.001), compared with group 2. In case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT, the study groups showed different treatment strategies. Group 2 continued the EVT immediately more often, without initiating therapy to treat the vasospasm first (9.6% vs 21.1%, p<0.001).ConclusionThere is disagreement among NIs about the clinical relevance of vasospasm during EVT and its management. There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.

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“…More than 10% of endovascular stroke treatments (EVTs) for acute ischemic stroke are associated with perioperative complications [1]. They include distal embolization to a new territory (4-6%), de novo stenosis of target vessels (3.4%), vessel perforation (0.6-4.9 %), dissection (0.6 -3.9%), groin hematoma (2 -10%) and vasospasm (3.9 -23%) [2][3][4]. Iatrogenic vasospasm is a common complication that occurs during stent retriever or contact aspiration instrumentation due to the vessel wall irritation during thrombectomy maneuvers.…”

Section: Introductionmentioning

confidence: 99%

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Jesser,

Nguyen,

Dmytriw

et al. 2023

Preprint

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Background and aim: The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT. Methods: We conducted an anonymous international online survey (April 04th to May 15th 2023) addressing treatment standards of neurointerventionalists (NI) practicing EVT. Several illustrative cases of patients with vasospasm during EVT were shown. Two study groups were compared according to the NI's opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis. Results: In total, 534 NI from 56 countries responded, of whom 51.5% had performed more than 200 EVT. Vasospasm was considered a complication potentially influencing the patient's outcome by 52.6% (Group 1) whereas 47.4% did not (Group 2). Physicians in Group 1 more often added vasodilators to their catheter flushes during EVT routinely (43.7% vs. 33.9%, p = 0.033) and more often treated severe large-vessel vasospasm with vasodilators (75.3% vs. 55.9%; p < 0.001), as well as extracranial vasospasm (61.4% vs. 36.5%, p < 0.001) and intracranial medium-vessel vasospasm (27.1% vs. 11.2%, p < 0.001), compared to Group 2. In case of a large-vessel vasospasm and residual and amenable medium vessel occlusion during EVT, the study groups showed different treatment strategies. Group 2 continued the EVT immediately more often, without initiating therapy to treat the vasospasm first (9.6% vs 21.1%, p < 0.001). Conclusion: There is disagreement among neurointerventionalists about the clinical relevance of vasospasm during EVT and its management. There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.

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Possible Contribution of the Aspiration Catheter in Preventing Post-stent Retriever Thrombectomy Subarachnoid Hemorrhage

Cited by 7 publications

References 43 publications

Nimodipine as Vasodilator in Guide Catheter Flush to Prevent Vasospasm During Endovascular Stroke Treatment

Nimodipine as Vasodilator in Guide Catheter Flush to Prevent Vasospasm During Endovascular Stroke Treatment

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

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