Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 2;5(1):57.
doi: 10.1186/s42466-023-00283-3.

Outcome analysis for patients with subarachnoid hemorrhage and vasospasm including endovascular treatment

Sina Burth  1 , Jan Meis  2 , Dorothea Kronsteiner  2 , Helena Heckhausen  1 , Klaus Zweckberger  3 , Meinhard Kieser  2 , Wolfgang Wick  1   4   5 , Christian Ulfert  6 , Markus Möhlenbruch  6 , Peter Ringleb  1 , Silvia Schönenberger  7
Affiliations

Outcome analysis for patients with subarachnoid hemorrhage and vasospasm including endovascular treatment

Sina Burth et al. Neurol Res Pract. .

Abstract

As a complication of subarachnoid hemorrhage (SAH), vasospasm substantially contributes to its morbidity and mortality. We aimed at analyzing predictors of outcome for these patients including the role of endovascular treatment (ET). Our database was screened for patients with SAH treated in our Neuro-ICU from 2009 to 2019. Clinical parameters including functional outcome (modified Rankin Scale, mRS of 0-2 or 3-6 at discharge and after a median follow-up of 18 months) and details about ET were gathered on 465 patients, 241 (52%) of whom experienced vasospasm. Descriptive analyses were performed to identify explanatory variables for the dichotomized mRS score. A logistic regression model was fitted on 241 patients with vasospasm including age, Hunt and Hess Score, extraventricular drainage (EVD), forced hypertension, ET and delayed cerebral ischemia (DCI). The model found a Hunt and Hess Score of 5 (OR = 0.043, p = 0.008), requirement of EVD (OR = 0.161, p < 0.001), forced hypertension (OR = 0.242, p = 0.001), ET (OR = 0.431, p = 0.043) and DCI (OR = 0.229, p < 0.001) to be negative predictors of outcome while age was not. Use of intraarterial nimodipine alone (OR = 0.778, p = 0.705) or including balloon angioplasty (OR = 0.894, p = 0.902) and number of ETs per patient (OR = 0.757, p = 0.416) were not significant in a separate model with otherwise identical variables. While DCI is clearly associated with poor outcome, the influence of ET on outcome remains inconclusive. Limited by their retrospective nature and an indication bias, these data encourage a randomized assessment of ET.

Keywords: Delayed cerebral ischemia; Endovascular treatment; Outcome; Subarachnoid hemorrhage; Vasospasm.

PubMed Disclaimer

Conflict of interest statement

The other authors have stated explicitly that there are no conflicts of interest in connection with this article. No funding was received to assist with the preparation of this manuscript.

References

    1. Aburto-Murrieta Y, Marquez-Romero JM, Bonifacio-Delgadillo D, Lopez I, Hernandez-Curiel B. Endovascular treatment: Balloon angioplasty versus nimodipine intra-arterial for medically refractory cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Vascular and Endovascular Surgery. 2012;46(6):460–465. doi: 10.1177/1538574412454585. - DOI - PubMed
    1. Andereggen L, Beck J, Z'Graggen WJ, Schroth G, Andres RH, Murek M, Haenggi M, Reinert M, Raabe A, Gralla J. Feasibility and safety of repeat instant endovascular interventions in patients with refractory cerebral vasospasms. AJNR American Journal of Neuroradiology. 2017;38(3):561–567. doi: 10.3174/ajnr.A5024. - DOI - PMC - PubMed
    1. Bonow RH, Young CC, Bass DI, Moore A, Levitt MR. Transcranial Doppler ultrasonography in neurological surgery and neurocritical care. Neurosurgical Focus. 2019;47(6):E2. doi: 10.3171/2019.9.FOCUS19611. - DOI - PubMed
    1. Boulouis G, Labeyrie MA, Raymond J, Rodriguez-Regent C, Lukaszewicz AC, Bresson D, Ben Hassen W, Trystram D, Meder JF, Oppenheim C, Naggara O. Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: A systematic review and meta-analysis. European Radiology. 2017;27(8):3333–3342. doi: 10.1007/s00330-016-4702-y. - DOI - PubMed
    1. Budohoski KP, Guilfoyle M, Helmy A, Huuskonen T, Czosnyka M, Kirollos R, Menon DK, Pickard JD, Kirkpatrick PJ. The pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhage. Journal of Neurology, Neurosurgery and Psychiatry. 2014;85(12):1343–1353. doi: 10.1136/jnnp-2014-307711. - DOI - PubMed

LinkOut - more resources