Introduction Cerebral vasospasm (CV) and delayed cerebral ischemia continue to be a devastating consequence of subarachnoid hemorrhage; however, few studies address factors that predictor failure of initial rescue therapy (refractory vasospasm). We sought to determine factors associated with refractory vasospasm.

Materials and Methods A retrospective chart review of consecutive patients admitted from 2017-2019 with spontaneous subarachnoid hemorrhage was done. Factors including degree of vasospasm, sex, age, Hunt Hess grade (HH), mFS, discharge mRS, type of IA therapy, distribution of vasospasm, and number of treatments were collected. Refractory CV was defined as requiring more than 2 therapeutic cerebral angiograms. Data was analyzed as categorical variables using the Fischer’s exact test as well as a binary regression analysis.

Results Out of 69 patients who developed delayed cerebral ischemia, 16 (23%) had refractory CV of which 11 (69%) had severe CV and 5 (31%) had moderate CV on their initial cerebral angiogram. Gender, type of aneurysm treatment (coil vs clip), HH, mFS, age and the type of intra-arterial calcium channel blocker used were not significantly associated with refractory CV (P>0.05). Patients with moderate- severe CV (100% vs 58%) and those with CV involving multiple vessels (100% vs 58%) were associated with refractory CV (P<0.05). 13 out of the 16 patients who developed angiographic improvement of CV with intra-arterial CCB on their first DSA progressed to develop refractory CV. Binary logistic regression indicates that the severity of CV on initial cerebral angiogram is a significant predictor of refractory CV (P<0.05). Patients with refractory vasospasm had higher mRS at discharge (P=0.05).

Conclusion Severity of CV on initial angiogram is a significant predictor of refractory CV.

Disclosures B. Ryu: None. T. White: None. T. Rebeiz: None. K. Shah: None. J. Turpin: None. H. Woo: None.