Use of the Cascade expandable net to treat cerebral vasospasm – initial clinical experience from a single centre with in vitro benchside tests

Abstract

Background The use of self-expanding stents to treat post-hemorrhagic cerebral vasospasm was recently described. We sought to determine the clinical efficacy of the Cascade device to treat delayed cerebral vasospasm (DCV). We performed benchside tests to determine the chronic outward force exerted by the Cascade in comparison to the Solitaire. Methods The chronic outward force (COF) of the Cascade M agile and Cascade L Agile was tested with equivalent tests of the Solitaire 4x20mm. Further tests to determine the forces generated in pre-formed tubes of 1.5–6 mm were performed using both fully and partially unsheathed Cascades. A retrospective review to identify all patients with aSAH and DCV treated with a Cascade device between January 2020 and July 2021. We recorded the treatment arterial vessel diameters and hemorrhagic or ischemic complications. Results In vitro the Cascade generated greater radial force than the Solitaire. The force generated by the Cascade M Agile at 1.5 mm was approximately 64% higher than the Solitaire 6x40mm and approximately 350% higher than the Solitaire 4x20mm. 4 patients with DCV were identified all of whom were treated with a cascade device. In all cases there was a significant improvement in the diameter of the vasospastic vessels treated with an average diameter increase of approximately 300%. There were no complications from the Cascade. Delayed CT angiography showed persistent dilatation of the segments treated with the Cascade at 24 h. Conclusion The Cascade is a safe and effective device when used to treat DCV secondary to aSAH. Larger studies are required to validate our initial results.

Delayed collapse of flow diverter due to acute severe vasospasm: another concern for flow diversion in ruptured aneurysms

“…Stents are protective against vasospasm as their outward resistive force helps to keep the spastic vessel patent for long term. Stent retrievers, the Comaneci device (Rapid Medical, Yokneam, Israel) and the Cascade expandable net (Perflow Medical, Israel) have been successfully used for the treatment of refractory vasospasm,4–6 but the radial force of stents is not always adequate to keep the vessel patent. The morphology of the deployed stent is dependent on complex interplay and balance between the outward resistive force of the stent and the inward force of contracting smooth muscles of the spastic vessel.…”

Neuroradiological diagnosis and therapy of cerebral vasospasm after subarachnoid hemorrhage

“…Instead, a mechanical radial force is gradually exerted on the spastic vascular wall by means of self-expansion after release of the stent retriever without the need for temporary occlusion. In addition, different novel non-occlusive stents are currently used for treating spasms [71][72][73]. In our institution we have had positive experiences with the Comaneci instrument with an adjustable and easy-to-control radial force for the endovascular treatment of CVS.…”

The Stream Device—A Retrospective Review of 51 Cases

“…Manually controlled, expandable, braided devices have been clinically used for the treatment of aneurysms [19][20][21][22][23] and, more recently, cerebral vasospasm [24,25]; however, their development and use in AIS are more recent occurrences. The Stream (Perflow Medical, Tel Aviv, Israel) device is a novel device with a braided structure that, via an actuator at the handle, can be expanded or contracted by the operator.…”