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Clinical predictors of delayed cerebral ischemia after subarachnoid hemorrhage: first experience with coil embolization in the management of ruptured cerebral aneurysms
  1. Yasuhiro Kawabata1,
  2. Fumihiko Horikawa1,
  3. Yasushi Ueno2,
  4. Masahiro Sawada1,
  5. Fumiaki Isaka1,
  6. Hidenori Miyake1
  1. 1Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan
  2. 2Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
  1. Correspondence to Dr Y Kawabata, Hamamatsu Rosai Hospital, Shizuoka, Japan 25 Shougen-cho, Higashi-ku, Hamamatsu 430-8525, Japan; ykawabata-kyt{at}umin.net

Abstract

Objective The purpose of this study was to clarify the clinical predictors of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH).

Methods 102 patients with ruptured cerebral aneurysms were treated (77 by clipping and 25 by coiling). 40 patients were male and 62 were female. Median age was 59 years (range 31–88). The modified Rankin Scale was used to assess functional outcomes 3 months after treatment or at discharge. The associations between potential clinical risk factors and DCI after SAH were assessed using the χ2 test.

Results 52 patients (51.0%) had a good outcome and 13 patients (12.7%) died despite treatment. DCI was observed in 26 patients and hydrocephalus was observed in 37 patients. There were marginal differences in clinical outcomes between the treatment groups (p=0.053), mainly because functional outcomes were significantly superior in the coiling group (p=0.04) in patients with severe SAH. DCI was seen less frequently in the coiling group than in the clipping group (4.0% vs 32.4%, p=0.001). The presence of hydrocephalus was significantly associated with the occurrence of DCI (p<0.001). Multivariate logistic regression analysis also showed that the treatment modality and the presence of hydrocephalus were independent risk factors for DCI.

Conclusion DCI was less frequently observed in the coiling group, and clinical outcomes were also superior in the coiling group, especially for patients with severe SAH. The results showed a significant correlation between DCI and hydrocephalus.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the committee of Hamamatsu Rosai Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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