Cerebral vasospasm following spontaneous subarachnoid hemorrhage: Angiographic pattern and its impact on the clinical course.

Cerebral vasospasm following spontaneous subarachnoid hemorrhage: Angiographic pattern and its impact on the clinical course.:

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Cerebral vasospasm following spontaneous subarachnoid hemorrhage: Angiographic pattern and its impact on the clinical course.

World Neurosurg. 2020 Apr 02;:

Authors: Ditz C, Leppert J, Neumann A, Krajewski KL, Gliemroth J, Tronnier VM, Küchler J

Abstract

OBJECTIVE: To analyze angiographic characteristics of cerebral vasospasm (CVS) after spontaneous subarachnoid hemorrhage (sSAH) and their potential impact on secondary infarction and functional outcome.

METHODS: Demographic, clinical and imaging data of sSAH patients with angiographic CVS admitted over a 6-year period were retrospectively analyzed.

RESULTS: 85 patients were included in final analysis. A total of 311 arterial territories in 85 angiographies demonstrated angiographic CVS. The anterior cerebral artery (ACA) was the most common site of angiographic CVS (42.1 %), followed by the middle cerebral artery (MCA) (26.7 %). In 29 angiographies (34%) CVS was found in more than 3 vessels and a bilateral pattern was identified in 53 cases (62%). Older age (3.24 [1.30-8.07], p = 0.012) was identified as the only significant risk factor for CVS-related infarction (OR 22.67, p = 0.015). Unfavorable outcome was associated with older age (OR 3.24, p = 0.023) and poor World Federation of Neurosurgical Societies (WFNS) grade (OR 3.64, p = 0.015). Analyses of angiographic characteristics did not reveal any risk factors for unfavorable outcome. We identified distal CVS as a significant risk factor for CVS-related infarction (OR 2.89, p=0.026).

CONCLUSIONS: Angiographic CVS after sSAB shows a specific distribution pattern in favor of ACA and MCA and mostly 2-3 affected vessels are affected, often bilaterally. Patients exhibiting distal CVS have a higher risk for CVS-related infarction and should be observed closely. However, the majority of angiographic characteristics did not allow conclusions about functional outcome nor the occurrence of CVS-related infarction in sSAH patients.

PMID: 32247799 [PubMed - as supplied by publisher]