Tenzingplasty Improves Vasospasm Outcomes with Tenzing Devices in Neurovascular Procedures

Introduction Vasospasm is a morbid and often fatal complication of intracranial pathologies. Typically caused by aneurysmal subarachnoid hemorrhage (aSAH), it can also occur in association with intracranial infections. Heterogeneity exists in treatment regimens, but management usually involves intensive medical therapy. This may often require augmentation with endovascular therapy, most commonly intra‐arterial calcium channel blocker infusion, with angioplasty 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, or Tenzingplasty, of various sizes chosen to best approximate native premorbid calibers of affected arteries. Methods According to IRB‐approved protocols, retrospective analysis of prospectively maintained procedural databases and medical records was performed for patients undergoing Tenzingplasty at five high‐volume cerebrovascular centers. Demographic and clinical features were recorded, including disease‐specific features of vasospasm, details of pre‐treatment management, noninvasive markers of vasospasm, technical elements of the Tenzingplasty procedure, and short‐term clinical outcomes. Per‐segment analysis was performed, including any treated arterial segment with narrowing >50%. The primary outcome was improvement of treated vessel narrowing to less than 50%. The primary safety outcome was any procedural complication. Secondary outcomes included absolute improvement in narrowing, post‐treatment velocities on transcranial Doppler (TCD), and need for repeat 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, excluding variables with p>0.20 in univariable tests to account for possible residual confounding. Results Twelve patients were treated with Tenzingplasty for vasospasm; 10 (83.3%) had aSAH, and 2 (16.7%) had meningitis. Tenzing devices were passed through 67 arterial segments. Among these, 56 (83.6%) had stenosis >50% and were included in the analysis. 73 passes were performed in total, with no procedural complications occurring after any treatment. All treated segments had improved narrowing, while 64 (95.5%) had residual narrowing <50%. 76.5% of segments interrogated with TCD following Tenzingplasty had normal velocities following treatment. Mean vessel narrowing improved from 79.9% ± 12.7 to 33.9% ± 14.2, with absolute improvement of narrowing 45.9% ± 16.6. Three (5.4%) segments required repeat endovascular therapy. In univariable and multivariable analysis, no demographic, clinical, or treatment variables were associated with any outcome measures. Conclusion Tenzingplasty performed for vasospasm was safe and effective, with all vessel narrowing improving and 95.5% having <50% residual narrowing following the procedure. No procedural complications occurred in any treated segment. Improvement in post‐treatment TCD velocities and low need for repeat endovascular therapy suggest durable clinical benefit.