Stent-retriever Use for post-SAH Vasospasm Angioplasty

Here is a case of bilateral severe ACA spasm post ACOM aneurysm rupture.  Long segments of proximal and distal ACA spasm offer excellent target for stent-retriever angioplasty

Notice three vessels arising from the ACOM complex (see ACA page for more info)

A week later there is perfusion abnormality and clinical deterioration

Right ICA

Left ICA

left A1 injection — Headway 021

Pericalossal

Trevo 4×30 stent-retriever in place

Resheathing the stent-triever. Do not pull like in a thrombectomy case. Just deploy, leave in there for a minute, and resheath, like Pipeline Flex

Proximal balloon plasty (Transform 3×5)

Post

Right side, deployment

All three ACOM-related vessels are treated

Post right

Pre and post. its not perfect by any means. but much better.

left side. also partial but better for sure.

Literature

https://www.ncbi.nlm.nih.gov/pubmed/30083794

https://www.ncbi.nlm.nih.gov/pubmed/27417185

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