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Original research
Relationship between cerebral vasospasm vascular territory and functional outcome after aneurysmal subarachnoid hemorrhage
  1. Tyler S Cole,
  2. Robert F Rudy,
  3. Erfan Faridmoayer,
  4. Sirin Gandhi,
  5. Claudio Cavallo,
  6. Joshua S Catapano,
  7. Ashutosh P Jadhav,
  8. Michael T Lawton,
  9. Felipe C Albuquerque,
  10. Andrew F Ducruet
  1. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Andrew F Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA; neuropub{at}


Background Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) contributes significant morbidity and mortality after brain aneurysm rupture. However, the association between vascular territory of vasospasm and clinical outcome has not been studied. We present a hypothesis-generating study to determine whether the location of vasospasm within the intracranial circulation is associated with functional outcome after SAH.

Methods A retrospective analysis of a prospective, intention-to-treat trial for aneurysmal SAH was performed to supplement trial outcomes with in-hospital angiographic imaging and treatment variables regarding vasospasm. The location of vasospasm and the position on the vessel (distal vs proximal) were evaluated. Modified Rankin scale (mRS) outcomes were assessed at discharge and 6 months, and predictive models were constructed.

Results A total of 406 patients were included, 341 with follow-up data at 6 months. At discharge, left-sided vasospasm was associated with poor outcome (odds ratio (OR), 2.37; 95% CI, 1.25 to 4.66; P=0.01). At 6 months, anterior cerebral artery (ACA) vasospasm (OR, 3.87; 95% CI, 1.29 to 11.88; P=0.02) and basilar artery (BA) vasospasm (OR, 6.22; 95% CI, 1.54 to 27.11; P=0.01) were associated with poor outcome after adjustment. A model predicting 6-month mRS score and incorporating vasospasm variables achieved an area under the curve of 0.85 and a net improvement in reclassification of 13.2% (P<0.01) compared with a previously validated predictive model for aneurysmal SAH.

Conclusions In aneurysmal SAH, left-sided vasospasm is associated with worse discharge functional status. At 6 months, both ACA and BA vasospasm are associated with unfavorable functional status.

  • Aneurysm
  • Angiography
  • CT Angiography
  • Hemorrhage
  • Stroke

Data availability statement

No data are available.

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Data availability statement

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  • Contributors TSC: study design, data analysis, drafting of manuscript. RFR: drafting of manuscript. EF: data acquisition. SG: data acquisition. CC: data acquisition. JSC: data acquisition, critical revision of manuscript. APJ: study design, critical review of manuscript. MTL: critical revision of manuscript. FCA: study design, study support, critical revision of manuscript. AFD: senior oversight, study guarantor, study design and conception, study support, critical revision of manuscript.

  • Funding Funding for the Barrow Ruptured Aneurysm Trial was originally obtained from the Barrow Neurological Foundation.

  • Competing interests AFD is a consultant for Medtronic (Dublin, Ireland), Penumbra (Alameda, CA), Cerenovus (Johnson & Johnson, New Brunswick, NJ), Stryker (Kalamazoo, MI), Koswire (Flowery Branch, GA), and Oculus (Menlo Park, CA). AFD also has an ownership interest in Aneuvas Technologies, Inc. (Flagstaff, AZ). FCA and AFD are on the editorial board of Journal of NeuroInterventional Surgery.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.