{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T08:18:21Z","timestamp":1794385101944,"version":"4.9.0"},"reference-count":28,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2022,8,10]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>We report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive patients undergoing Comaneci mechanical dilatation for vasospasm were extracted from prospectively maintained registries in 11 North American centers (2020\u20132022). Intra-arterial vasodilators (IAV) were allowed, with the Comaneci device utilized after absence of vessel dilation post-infusion. Pre- and post-vasospasm treatment scores were recorded for each segment, with primary radiological outcome of score improvement post-treatment. Primary clinical outcome was safety\/device-related complications, with secondary endpoints of functional outcomes at last follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 129 vessels in 40 patients (median age 52 years; 67.5% females) received mechanical dilation, 109 of which (84.5%) exhibited pre-treatment severe-to-critical vasospasm (ie, score 3\/4). Aneurysmal subarachnoid hemorrhage was the most common etiology of vasospasm (85%), with 65% of procedures utilizing Comaneci-17 (92.5% of patients received IAV). The most treated segments were anterior cerebral artery (34.9%) and middle cerebral artery (31%). Significant vasospasm drop (pre-treatment score (3\u20134) to post-treatment (0\u20132)) was achieved in 89.9% of vessels (96.1% of vessels experienced \u22651-point drop in score post-treatment). There were no major procedural\/post-procedural device-related complications. Primary failure (ie, vessel unresponsive) was encountered in one vessel (1 patient) (1\/129; 0.8%) while secondary failure (ie, recurrence in previously treated segment requiring retreatment in another procedure) occurred in 16 vessels (7 patients) (16\/129; 12.4%), with median time-to-retreatment of 2\u2009days. Favorable clinical outcome (modified Rankin Scale 0\u20132) was noted in 51.5% of patients (median follow-up 6 months).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Comaneci device provides a complementary strategy for treatment of refractory vasospasm with reasonable efficacy\/favorable safety. Future prospective trials are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnis-2022-019272","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T17:22:05Z","timestamp":1661361725000},"page":"864-870","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["COManeci MechANical Dilation for vasospasm (COMMAND): multicenter experience"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2082-6892","authenticated-orcid":false,"given":"Mohamed 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