Recurrent vasospasm after endovascular treatment in subarachnoid hemorrhage.

Abstract

OBJECTIVES:

the frequency and predictors of recurrent symptomatic and angiographic vasospasm after angioplasty or intra-arterial chemical vasodilatation (IACV) in patients with subarachnoid hemorrhage (SAH) are not well characterized.

METHODS:

a retrospective review of serial clinical and angiographic data was conducted between 7/2001-6/2008 on spontaneous SAH patients who underwent endovascular therapy for symptomatic vasospasm.

RESULTS:

of 318 SAH patients, symptomatic vasospasm occurred in 80 (25%) and endovascular intervention was performed on 69 (22%) patients. Of these 69 patients, all received IACV in 274 vessels and 33 also underwent angioplasty in a total of 76 vessels. Recurrent angiographic vasospasm occurred in the same vessel segment in 9/23 (39%) patients who received both angioplasty + IACV compared to 40/49 (82%) of patients who received IACV alone (P < 0.001). Recurrent symptomatic vasospasm occurred in 10/26 (38%) angioplasty + IACV patients compared to 28/37 (76%) patients who received IACV alone (P = 0.003). The modified-Fisher Score, A1 spasm, distal and multi-vessel vasospasm predicted recurrent angiographic spasm after IACV alone (P < 0.05). Procedural complications occurred in 4% of IACV alone patients and 6% of angioplasty + IACV patients (P = 0.599).

CONCLUSIONS:

recurrent angiographic or symptomatic vasospasm is not uncommon after angioplasty + IACV, but appears to occur significantly less than after IACV alone, without any increase in procedural complications.

• Authors: Jennifer A Frontera, Arjun Gowda, Christina Grilo, Errol Gordon, David Johnson, H Richard Winn, Joshua B Bederson, Aman Patel
• Journal: Acta neurochirurgica. Supplement (Acta Neurochir Suppl) Vol. 110 Issue Pt 2 Pg. 117-22 ( 2011) ISSN: 0065-1419 [Print] Austria
• PMID: 21125456 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Angiography (methods)
• Chi-Square Distribution
• Endovascular Procedures (adverse effects)
• Female
• Humans
• Male
• Middle Aged
• Outcome Assessment, Health Care (methods)
• Recurrence
• Retrospective Studies
• Severity of Illness Index
• Subarachnoid Hemorrhage (complications, surgery)
• Tomography Scanners, X-Ray Computed
• Vasospasm, Intracranial (diagnostic imaging, etiology)