O-039 Mechanical treatment of intracranial vasospasm using the comaneci device: multicenter experience (2022)

<h3>Introduction</h3> We report large multicenter experience utilizing the Comaneci device (Rapid Medical, Yokneam, Israel) for endovascular treatment of medically-refractory intracranial vasospasm. <h3>Methods</h3> Series of consecutive patients undergoing Comaneci mechanical dilatation for intracranial vasospasm, regardless of etiology, were extracted from prospectively-maintained registries in 7 North-American cerebrovascular centers (2019–2021). Intra-arterial vasodilators were allowed, with Comaneci device only utilized after absence of vessel dilation post-infusion. Pre- and post-vasospasm treatment scores were recorded for each treated segment, with primary outcome of radiological improvement in vasospasm score post-treatment. The primary clinical outcome was device safety profile and procedural device-related complications, with secondary endpoints of functional outcomes at last available follow-up. <h3>Results</h3> 29 patients undergoing endovascular vasospasm treatment utilizing Comaneci device (median age 53; 69% females). Aneurysmal subarachnoid hemorrhage was the most common etiology of vasospasm (82.8%), with 65.5% of dilation procedures performed utilizing Comaneci-17 device and 89% of patients receiving intra-arterial vasodilators. The most treated segments were the anterior cerebral artery (40.4%) followed by middle cerebral artery (29.8%). A total 94 vessels received mechanical dilation; 74 of which had pre-treatment severe to critical vasospasm scores (i.e., vasospasm score of 3 or 4). Significant vasospasm drop defined as change from pre-treatment score of (3–4) to post-treatment of (0–2) was achieved in 89.2% of the cases, with 94.7% of the vessels (89 of 94) experiencing at least 1-point drop in vasospasm severity post- treatment. There were no major procedural or post-procedural device-related complications (i.e., vessel rupture/dissection or post-procedure intracerebral hemorrhage, etc.) encountered in any of the patients. Primary treatment failure (i.e., vessel unresponsive to treatment) was encountered in 1 vessel in 1 patient (1/94; 1.1%) while secondary treatment failure (i.e., vasospasm recurrence in previously treated segment requiring retreatment in another procedure) was noted in 16 vessels in 7 patients (16/94; 17%), with median time-to-retreatment of 2 days. Favorable clinical outcome of modified Rankin Scale score of 0–2 was noted in 52% of the patients over a median of 6 months of clinical follow-up. <h3>Conclusion’</h3> The Comaneci device provides a feasible complimentary strategy for endovascular treatment of refractory intracranial vasospasm with reasonable efficacy and favorable safety profile. Future prospective trials are warranted for further investigation. <h3>Disclosures</h3> <b>M. Salem:</b> None. <b>J. Khalife:</b> None. <b>S. Desai:</b> None. <b>V. Sharashidze:</b> None. <b>C. Badger:</b> None. <b>A. Luisa Kuhn:</b> None. <b>A. Monteiro:</b> None. <b>A. Siddiqui:</b> None. <b>E. Levy:</b> None. <b>A. Thomas:</b> None. <b>M. Lang:</b> None. <b>J. Burkhardt:</b> None. <b>A. Puri:</b> None. <b>B. Gross:</b> None. <b>E. Nossek:</b> None. <b>A. Hassan:</b> None. <b>H. Shaikh:</b> None. <b>B. Jankowitz:</b> None.