pRELACSS: pRELAX retraction to relieve arterial cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a retrospective multicenter experience

Background Balloon angioplasty for cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (aSAH) is restricted to proximal segments; intra-arterial vasodilators act only transiently. The Stent-ReLACSS maneuver—deployment of a self-expanding device followed by retraction through the spastic segment—has so far been reported from a single center. Methods A retrospective analysis was performed of consecutive patients treated with Stent-ReLACSS using pRELAX at four centers. Diameters were measured on calibrated angiography at baseline, during vasospasm, and immediately after the maneuver, before any additional intra-arterial vasodilator. Vasospasm was graded 0–4 from the measured diameters; the primary endpoint was a post-treatment grade of 0–1 per segment. Distal segments were treated with a modified technique (30 s incubation, stepwise retraction). Results Forty-five patients with 115 treated segments (50.4% distal) were included; 93.9% of segments showed high-grade or severe vasospasm. The primary endpoint was reached in 96 of the 115 segments (83.5%) and the grade improved in 111 (96.5%). Success was similar in distal and proximal segments (86.2% vs 80.7%). No patient required retreatment for recurrent vasospasm; one M1 segment with insufficient response was dilated with another device in the same session. Thirty-six (80.0%) received a vasodilator afterwards. Procedure-related events occurred in three patients (6.7%), one requiring thrombectomy; none caused a permanent deficit. A modified Rankin Scale score of 0–2 at 3–6 months was reached by 32 of 42 patients (76.2%). Conclusions Stent-ReLACSS with pRELAX produced substantial immediate angiographic improvement and was technically feasible in distal segments poorly suited to balloon angioplasty. No retreatment was required, although most patients also received vasodilators.