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Case series
Safety and outcomes of simultaneous vasospasm and endovascular aneurysm treatment (SVAT) in subarachnoid hemorrhage
  1. Doniel Drazin1,
  2. Vernard S Fennell2,
  3. Edward Gifford3,
  4. Carlito Lagman1,
  5. Kunakorn Atchaneeyasakul4,
  6. Randall C Edgell5,
  7. Mahmoud Rayes6,
  8. Andrew Xavier7,
  9. Muhammad S Hussain8,
  10. Rishi Gupta8,
  11. Junaid S Kalia9,
  12. Osama O Zaidat9,
  13. Italo Linfante10,
  14. Raul G Nogueira11,
  15. Thanh Nguyen12,
  16. Jamary Oliveira-Filho13,
  17. Alexandre D M Barros13,
  18. Alan Boulos14,
  19. Michael J Alexander1,
  20. Dileep R Yavagal14
  1. 1Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
  3. 3Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
  4. 4Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
  5. 5Departments of Surgery and Neurology, Saint Louis University, St. Louis, Missouri, USA
  6. 6Department of Neurology, Wayne State University, Detroit, Michigan, USA
  7. 7Michigan Head & Spine Institute, Clinton, Michigan, USA
  8. 8Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  9. 9Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  10. 10Department of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  11. 11Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  12. 12Department of Neurology, Boston University, Boston, Massachusetts, USA
  13. 13Department of Neurology, University of Bahia, Salvador, Brazil
  14. 14Department of Neurology, Albany Medical College, Albany, New York, USA
  1. Correspondence to Dr Dileep R Yavagal, Department of Neurology and Neurosurgery, Division of Interventional Neurology, 1120 NW 14th Street, Miami, FL 33136, USA; DYavagal{at}


Background Simultaneous vasospasm and endovascular aneurysm treatment (SVAT) has been shown to be effective with good clinical outcomes in small series, but these studies have not examined predictive factors for clinical outcome after treatment.

Objective To identify the safety and efficacy of SVAT in a large multicenter patient cohort and evaluate prognostic markers of clinical outcome following SVAT.

Methods This study retrospectively enrolled 50 consecutive patients undergoing SVAT at 11 different centers. We analyzed Hunt and Hess and Fisher grades, aneurysm location, angiographic vasospasm grade, Glasgow Outcome Scale (GOS) at discharge, and 90-day modified Rankin Scale (mRS) scores.

Results A total of 50 patients undergoing SVAT between the years 2003 and 2009 were identified. Patients presented, on average, 6.48±4.45 days after subarachnoid hemorrhage. Hunt and Hess and Fisher grades were 1 (n=7), 2 (n=12), 3 (n=14), 4 (n=15), 5 (n=2), and 3 and 4 (n=33), respectively. Aneurysm location was distributed as follows: anterior (n=32), posterior (n=16), anterior and posterior (n=2). Patients with good clinical condition (Hunt and Hess score 1–3) had significantly higher odds of surviving (OR=17.5, 95% CI 1.9 to 161.5), favorable GOS (OR=4.2, 95% CI 1.2 to 14.8), and favorable 90-day mRS (OR=4.2, 95% CI 1.2 to 14.8).

Conclusions SVAT is safe, with the majority of patients achieving good clinical outcome. Patients with lower Hunt and Hess grades have higher odds of surviving and favorable clinical prognosis.

  • Aneurysm
  • Subarachnoid
  • Hemorrhage
  • Embolic
  • Balloon

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  • Correction notice This article has been corrected since it published Online First. The corresponding author, Dileep R Yavagal's, name has been corrected as well as the corresponding address.

  • Contributors All authors provided substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests RCE: consultant to Penumbra Inc. RG: Stryker, Covidien, Rapid Medical—modest, consultant/advisory board; associate editor Journal of Neuroimaging and Neurointerventional Surgery, modest; royalties UpToDate—modest. OOZ: Stryker, Genentech, Covidien—modest, research grant; Codman, Stryker, Penumbra, Covidien—modest, honoraria; expert witness Galaxy Therapeutics LLC—modest, ownership interest; NIS StrokeNet, Penumbra, Covidien, Codman, Stryker—modest, consultant/advisory board. IL: consultant for Medtronic, Stryker, and Penumbra, a proctor for Pipeline Embolic Device and Barrel (Medtronic) and a stockholder for Surpass and InNeuro Co. RGN: Stryker Neurovascular Trevo-2 Trial principal investigator—modest; DAWN Trial principal investigator—no compensation; Medtronic SWIFT Trial steering committee—modest; SWIFT Prime Trial steering committee—no compensation; STAR Trial angiographic core laboratory—significant; Penumbra 3D Separator Trial executive committee—no compensation; editor-in-chief Interventional Neurology Journal—no compensation. TN: Penumbra (Data Safety Monitoring Board). MJA: consultant with Stryker Neurovascular and Penumbra, Inc. DRY: consultant/advisory board member to a modest degree with Stryker Neurovascular. The remaining authors have no disclosures to report.

  • Ethics approval Institutional review board.

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

  • More info An abstract of this manuscript, entitled ‘US Multicenter Study of Endovascular Therapy in Ruptured Cerebral Aneurysms With Parent Artery Vasospasm’, was published in Stroke (2010;41(4)) and presented at the International Stroke Conference 2010.