“Stent Retraction to ReLieve Arterial Cerebral vasoSpasm Caused by SAH” (Stent-ReLACSS) Using pRELAX for the Treatment of Posthemorrhagic Cerebral Vasospasm

Cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (aSAH) remains the leading cause of delayed mortality and neurological deterioration after treatment of ruptured aneurysms, despite overall improvements in therapeutic and diagnostic measures. However, they are often insufficient, especially in severe or recurrent vasospasm. Treatments for CVS described in the literature include medical angioplasty with intra-arterial (IA) vasodilators, long-term intra-arterial infusion of nimodipine, and dilation of large arteries with (non)compliant balloons, stent retrievers, or by implantation of self-expanding stents. However, a significant number of patients with CVS remain underserved. “Stent Retraction to reLieve Arterial Cerebral vasoSpasm caused by SAH” (Stent-ReLACSS) using pRELAX is a new mechanical treatment for posthemorrhagic CVS with promising results. A 28-year-old man was referred to us in a state of clinical deterioration with decreased vigilance due to spontaneous subarachnoid hemorrhage (SAH). Angiography revealed an aneurysm at the origin of the left posterior inferior cerebellar artery (PICA), which was treated with a flow diverter (FD). Ten days after SAH, the patient presented with diffuse CVS. The basilar artery (BA) was treated with medical vasospasmolysis, while the middle cerebral artery (MCA) and internal carotid artery (ICA) were treated with mechanical vasospasmolysis using pRELAX. Medical vasospasmolysis of the BA had only a short-term effect and required five repeat treatments over the next 6 days. After Stent-ReLACSS treatment with pRELAX, no recurrent CVS existed in the MCA and ICA segments. Follow-up examinations showed no vascular injury or territory ischemia. The patient made a full recovery during the postdischarge period. The treatment of posthemorrhagic vasospasm with “Stent-ReLACSS” is the main topic of this chapter.