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Case series
Endovascular treatment for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: predictors of outcome and retreatment
  1. Jennifer D Sokolowski1,
  2. Ching-Jen Chen1,
  3. Dale Ding2,
  4. Thomas J Buell1,
  5. Daniel M Raper1,
  6. Natasha Ironside3,
  7. Davis G Taylor1,
  8. Robert M Starke4,
  9. Kenneth Liu1
  1. 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
  2. 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  3. 3Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
  4. 4Department of Neurological Surgery, University of Miami, Miami, Florida, USA
  1. Correspondence to Dr Ching-Jen Chen, Department of Neurological Surgery,University of Virginia Health System, Charlottesville, Virginia 22908, USA; chenjared{at}gmail.com

Abstract

Objective Although endovascular therapy has been widely adopted for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH), its effect on clinical outcomes remains incompletely understood. The aims of this retrospective cohort study are to evaluate the outcomes of endovascular intervention for post-aSAH vasospasm and identify predictors of functional independence at discharge and repeat endovascular vasospasm treatment.

Methods We assessed the baseline and outcomes data for patients with aSAH who underwent endovascular vasospasm treatment at our institution, including intra-arterial (IA) vasodilator infusion and angioplasty. Statistical analyses were performed to determine factors associated with good outcome at discharge (modified Rankin Scale 0–2) and repeat endovascular vasospasm treatment.

Results The study cohort comprised 159 patients with a mean age of 52 years. Good outcome was achieved in 17% of patients at discharge (26/150 patients), with an in-hospital mortality rate of 22% (33/150 patients). In the multivariate analysis, age (OR 0.895; p=0.009) and positive smoking status (OR 0.206; p=0.040) were negative independent predictors of good outcome. Endovascular retreatment was performed in 34% (53/156 patients). In the multivariate analysis, older age (OR 0.950; p=0.004), symptomatic vasospasm (OR 0.441; p=0.046), initial treatment with angioplasty alone (OR 0.096; p=0.039), and initial treatment with combined IA vasodilator infusion and angioplasty (OR 0.342; p=0.026) were negative independent predictors of retreatment.

Conclusion We found a modest rate of functional independence at discharge in patients with aSAH who underwent endovascular vasospasm treatment. Older patients and smokers had worse functional outcomes at discharge. Initial use of angioplasty appears to decrease the need for subsequent retreatment.

  • aneurysm
  • angioplasty
  • balloon
  • subarachnoid
  • stroke

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Footnotes

  • Contributors JDS: conception/design of study, acquisition of data, drafting of manuscript, critically revising manuscript, final approval of the manuscript, agreement to be accountable for all aspects of the work; C-JC, DD: conception/design of study, analysis/interpretation of data, drafting of manuscript, critically revising manuscript, final approval of the manuscript, agreement to be accountable for all aspects of the work; TJB, DMR, NI, DGT, RMS, KL: critically revising manuscript, final approval of the manuscript, agreement to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Ethics approval IRB of University of Virginia.

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

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