Repurposing a Dual-Head Programmable Power Injector for Controlled Intra-Arterial Vasodilator Delivery During...

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage remains a leading cause of morbidity and mortality. Endovascular treatment with intra-arterial vasodilators is established for medically refractory vasospasm, yet medication delivery relies on manual hand-syringe injection with limited control over infusion rate and volume. In this proof-of-concept technical note, we describe a workflow innovation repurposing a dual-head programmable power injector (Nemoto PRESS DUO elite, Nemoto Kyorindo) for simultaneous contrast administration and controlled vasodilator infusion during endovascular vasospasm treatment. One chamber delivers contrast for angiographic runs, while the other contains a triple vasodilator cocktail of verapamil, nicardipine, and nitroglycerin, delivered via the injector's programmable Infusion Mode at operator-defined flow rates and volumes. This closed-system, dual-chamber architecture eliminates tableside syringe exchanges, reduces the risk of air entrainment, and enables precise, reproducible multi-agent delivery. In our experience with 9 patients (12 treatment sessions), the injector-based workflow facilitated routine use of the triple vasodilator cocktail with angiographic improvement observed in all sessions. Fluoroscopy time, radiation dose, contrast volume, and total procedural duration did not differ significantly from those of a historical manual-injection cohort, which served as a procedural workflow reference. Because the manual cohort received a different vasodilator regimen without nicardipine, the two cohorts are pharmacologically unmatched and angiographic outcomes were not compared between groups. No procedural complications related to the delivery method occurred. These preliminary findings suggest the dual-head programmable injector provides a feasible, ergonomic, and reproducible closed-system workflow for intra-arterial vasodilator delivery during cerebral vasospasm treatment, with broader applicability to other intra-arterial drug delivery settings.