Introduction Large-artery vasospasm (CVS) after aneurysmatic subarachnoid hemorrhage (aSAH) can reduce cerebral perfusion and cause severe neurological deficits. Delayed recognition of CVS risks the success of endovascular spasmolysis. An analysis of potential risk factors could be used to enable risk stratification for early therapeutic interventions.

Aim of Study To confirm established and identify unknown risk factors for CVS at the time of aneurysm occlusion.

Methods We compared 853 aSAH patients (mean age 57) treated at our center between 01/2006 and 03/2020. Patients with and without CVS were compared based on demographic, clinical, and radiographic parameters at the time of aneurysm occlusion. CVS was defined as a blood flow velocity of >200 cm/s in large intracranial arteries or the occurrence of secondary neurological deficits without competing causes. Cohort differences were included as predictors in a multivariate analysis to address confounding. Logistic regression models were used to determine odds ratios (OR) for the presence of CVS for each predictor.

Results 32% developed CVS. CVS was associated with age, female sex, aneurysm location, mFisher score, Barrow Neurological Institute (BNI) score, and surgical interventions in univariate analysis. Multivariable regression analysis identified BNI score (OR: 1.33, p = 0.002), decompressive craniectomy (OR: 1.93, p = 0.005), and aneurysm clipping (OR: 2.22, p < 0.001), as only independent risk factors after correction for age, sex, aneurysm site, and clinical severity.

Conclusion Young patient age, female sex, high BNI scores, and surgical interventions are associated with an increased likelihood of developing CVS after SAH.

Disclosure of Interest no.