Tenzingplasty for cerebral vasospasm following subarachnoid hemorrhage or meningitis: multicenter initial experience

Cerebral vasospasm is a serious complication of intracranial pathologies. Treatment involves intensive medical therapy that may require augmentation with endovascular therapy, most commonly intra-arterial calcium channel blocker infusion. Angioplasty is historically reserved for refractory cases at risk for infarct. Given the risks of iatrogenic complications with angioplasty, alternative mechanical therapies have been explored. This series examines Dotter technique mechanical dilatation performed with Tenzing devices, referred to as Tenzingplasty.

Methods

Institutional review board approved retrospective analysis was performed for patients undergoing Tenzingplasty at five high-volume cerebrovascular centers. Demographic, clinical, and treatment details were recorded. Per-segment analysis was performed for treated segments with narrowing ≥50%. Primary outcomes were absolute improvement of treated vessel narrowing and improvement to <50% baseline diameter. The primary safety outcome was any procedural complication. Secondary outcomes included degree of improvement and need for repeat mechanical therapy. Univariable and multivariable analyses were performed as appropriate.

Results

Fourteen patients were treated with Tenzingplasty for vasospasm; 12 (85.7%) had aneurysmal subarachnoid hemorrhage and 2 (14.3%) had meningitis. Eighty-two arterial segments had 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%. Three (3.7%) segments required repeat mechanical therapy. No demographic, clinical, or treatment variables were associated with the primary outcomes.

Conclusions

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