Tenzingplasty for Cerebral Vasospasm Following Subarachnoid Hemorrhage and Meningitis: Multicenter Initial Experience

Cerebral vasospasm is a morbid complication of intracranial pathologies. Heterogeneity exists in treatment regimens, but management usually involves intensive medical therapy that may require augmentation with endovascular therapy, most commonly intra-arterial CCB infusion; angioplasty is historically reserved for refractory cases with a high risk for permanent neurological deficits. Given the high risk of iatrogenic complications with balloon angioplasty, alternative mechanical therapies have been explored. This series examines Dotter technique mechanical dilatation performed with Tenzing devices (Tenzingplasty).

Methods

IRB-approved retrospective analysis of prospectively maintained procedural databases and medical records was performed for patients undergoing Tenzingplasty at five high-volume cerebrovascular centers. Demographics, clinical features, and treatment details were recorded. Per-segment analysis was performed, including any treated arterial segment with narrowing ≥50%. The primary outcomes were improvement of treated vessel narrowing and improvement to less than 50% of baseline diameter. The primary safety outcome was any procedural complication. Secondary outcomes included absolute improvement in narrowing and need for repeat mechanical endovascular therapy to be performed on a previously targeted segment. Statistical analysis was performed with the Exact test for non-continuous variables and T-tests for continuous variables. Mixed effects linear and logistic regression analysis was then performed as appropriate for multivariable analysis.

Results

Fourteen patients were treated with Tenzingplasty for vasospasm; 12 (85.7%) had aSAH, and 2 (14.3%) had meningitis. Tenzing devices were passed through 82 arterial segments with narrowing ≥50%. All treated segments had improved narrowing, with 78 (95.1%) having residual narrowing <50%. No procedural complications occurred. Mean (+/-SD) vessel narrowing improved from 80+/-13% to 34+/-14%, with absolute improvement of narrowing 46+/-17%. Three (3.7%) segments required repeat mechanical endovascular therapy. In univariable and multivariable analysis, no demographic, clinical, or treatment variables were associated with any outcome measures.

Conclusion

Tenzingplasty performed for cerebral vasospasm was safe and effective, with vessel narrowing improving in all treated segments. No procedural complications occurred in any treated segment. Low need for repeat mechanical endovascular therapy suggests a durable effect. Further investigation is warranted.