Cerebral vasospasm is a source of morbidity and mortality, not only associated with aneurysmal subarachnoid hemorrhage (SAH) but also with endovascular procedures. Treatment of vasospasm associated with SAH include trans-luminal balloon angioplasty and intra-arterial delivery of vasodilator medications. We present a case report of a patient who underwent a mechanical thrombectomy for stroke and suffered from vasospasm. This severe flow-limiting vasospasm was successfully treated with the Trevo stent device. Although stent retrievers have become more widespread for thrombectomy, vasospasm treatment has not been often described in the literature. Further study is needed to determine if this is a viable technique for treating resistant vasospasm.
Mascia L and Del Sorbo L. Diagnosis and management of vasospasm. F1000 Med Rep 2009; 1. doi:10.3410/m1-33.
2.
GathierCSvan den BerghWMvan der JagtM, et al. Induced Hypertension for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a randomized clinical trial. Stroke2018; 49: 76–83.
3.
ConnollyESJrRabinsteinAACarhuapomaJR, et al. Guidelines for the management of aneursymal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke2012; 43: 1711–1737.
4.
PickardJDMurrayGDIllingworthR, et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ1989; 298: 636–642.
5.
JestaedtLPhamMBartschAJ, et al. The impact of balloon angioplasty on the evolution of vasospasm-related infarction after aneurysmal subarachnoid hemorrhage. Neurosurgery2008; 62(3): 610–617. discussion 610-617.
6.
BadjatiaNTopcuogluMAPryorJC, et al. Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm. AJNR Am J Neuroradiol2004; 25(5): 819–826.
7.
GrallaJSchrothGRemondaL, et al. Mechanical thrombectomy for acute ischemic stroke: thrombus-device interaction, efficiency, and complications in vivo. Stroke2006; 37(12): 3019–3024.
8.
GonsalesDGracasFDSantosR, et al. Reversible cerebral vasoconstriction syndrome as an unusual complication of a dural arteriovenous fistula treated with onyx embolization. World Neurosurg2018; 115: 341–345.
QureshiAILuftARSharmaM, et al. Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II – Clinical aspects and recommendations. Neurosurgery2000; 46(6): 1360–1375. discussion 1375–1366.
11.
WeirBGraceMHansenJ, et al. Time course of vasospasm in man. J Neurosurg1978; 48(2): 173–178.
12.
CahillJCalvertJWZhangJH. Mechanisms of early brain injury after subarachnoid hemorrhage. J Cereb Blood Flow Metab2006; 26(11): 1341–1353.
13.
PlutaRM. Delayed cerebral vasospasm and nitric oxide: review, new hypothesis, and proposed treatment. Pharmacy Ther2005; 105(1): 23–56.
14.
OstrowskiRPColohanARZhangJH. Molecular mechanisms of early brain injury after subarachnoid hemorrhage. Neurol Res2006; 28(4): 399–414.
15.
GoyalMDemchukAMMenonBK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med2015; 372(11): 1019–1030.
16.
HokimotoSMizunoYSuetaD, et al. High incidence of coronary spasm after percutaneous coronary interventions: comparison between new generation drug-eluting stent and bare-metal stent. Int J Cardiol2015; 182: 171–173.
17.
NogueiraRGJadhavAPHaussenDC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med2018; 378(1): 11–21.
18.
DingD. Endovascular mechanical thrombectomy for acute ischemic stroke: a new standard of care. J Stroke2015; 17(2): 123–126.
ZubkovYNNikiforovBMShustinVA. Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochirurgica1984; 70(1): 65–79.
21.
BauerAMRasmussenPA. Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol2014; 5: 72.
22.
EddlemanCSHurleyMCNaidechAM, et al. Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm. Neurosurg Focus2009; 26(3): E6.
23.
BhogalPParaskevopoulosDMakalandaHL. The use of a stent-retriever to cause mechanical dilatation of a vasospasm secondary to iatrogenic subarachnoid haemorrhage. Interv Neuroradiol2017; 23(3): 330–335.
24.
BhogalPLohYBrouwerP, et al. Treatment of cerebral vasospasm with self-expandable retrievable stents: proof of concept. J Neurointerven Surg2017; 9: 52–59.
25.
KwonHLeeYKohH. Long-term results of angioplasty using stent-retrievers for cerebral vasospasm in subarachnoid hemorrhage patients. J Neurointerv Surg2017; 9(Suppl 1): A29–A29.
26.
RasmussenRBacheSStavngaardT, et al. Real-time changes in brain tissue oxygen during endovascular treatment of cerebral vasospasm. Acta Neurochir Suppl2015; 120: 183–186.
MendoncaNFloresAPagolaJ, et al. Trevo versus solitaire a head-to-head comparison between two heavy weights of clot retrieval. J Neuroimaging2014; 24(2): 167–170.
