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Case series
Severity of cerebral vasospasm associated with development of collaterals following aneurysmal subarachnoid hemorrhage
  1. Fawaz Al-Mufti1,2,
  2. Jens Witsch1,3,
  3. Nathan Manning1,
  4. Michael Crimmins4,5,
  5. Krishna Amuluru1,
  6. Sachin Agarwal1,
  7. Soojin Park1,
  8. Joshua Z Willey1,
  9. Hooman Kamel4,
  10. E Sander Connolly Jr1,
  11. Philip M Meyers1,
  12. Jan Claassen1
  1. 1 Department of Neurology and Neurosurgery, Columbia University Medical Center, New York City, New York, USA
  2. 2 Departments of Neurology, Neurosurgery, and Radiology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
  3. 3 Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4 Department of Neurology and Neurosurgery, Weill Cornell Medical Center, New York City, New York, USA
  5. 5 Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  1. Correspondence to Dr. Fawaz Al-Mufti, Departments of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA; fawazalmufti{at}


Introduction Cerebral collateral circulation has been studied extensively in ischemic stroke where it has been shown to be a predictor of reperfusion, final infarct size, and outcome. Little is known about the significance of the collaterals in the setting of aneurysmal subarachnoid hemorrhage (aSAH). We sought to evaluate the effect of cerebral vasospasm on the development of cerebral collaterals following aneurysmal subarachnoid hemorrhage and the effects of the latter on delayed cerebral ischemia (DCI).

Methods We retrospectively evaluated 64 aSAH patients with evidence of DCI between day 5 and 7, enrolled in a prospectively maintained observational cohort study. Angiograms were evaluated by four blinded neurointerventionalists. We compared good collateral grades to poor collateral grades, additionally we compared enrolled individuals with any collaterals versus patients who had no collaterals.

Results Inter-rater reliability for collateral grades was substantial (weighted kappa 0.632). Mild vasospasm was more frequent in patients with poor collateral grades compared with patients with good collateral grades (32% vs 4% P=0.012). There was no difference between the collateral groups with regards to DCI, functional, or cognitive outcome. Patients adjudicated to have any collaterals were more likely to have severe vasospasm (62% vs 33% P=0.023) and less likely to have mild vasospasm (37% vs 9% P=0.007). In a multivariable model, vasospasm severity remained associated with collateral status, while aneurysm location was not.

Conclusions The severity of vasospasm following aSAH was associated with the development of collaterals. There was no difference between collateral grades with regards to DCI or outcome.

  • subarachnoid
  • aneurysm

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  • Contributors Study concept and design: FA-M. Acquisition, analysis, or interpretation of data: all authors. Drafting the article: FA-M. Critically revising the article: FA-M. Administrative, technical, or material support: FA-M. Statistical analysis: FA-M. Study supervision: FA-M.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Columbia University Institutional Board Review Committee.

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