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Hemorrhagic stroke
Original research
Risk identification for the development of large-artery vasospasm after aneurysmatic subarachnoid hemorrhage – a multivariate, risk-, and location-adjusted prediction model
  1. Julian Schwarting1,2,3,
  2. Dominik Trost1,
  3. Carolin Albrecht4,
  4. Ann-Kathrin Jörger4,
  5. Claus Zimmer1,
  6. Maria Wostrack4,
  7. Bernhard Meyer4,
  8. Jannis Bodden1,
  9. Tobias Boeckh-Behrens1
  1. 1Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  2. 2Department of Radiology/Neuroradiology, BGU, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany
  3. 3Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
  4. 4Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  1. Correspondence to Dr Julian Schwarting, Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; julian.schwarting{at}tum.de

Abstract

Background Vasospasm of the large cerebral arteries (CVS) after aneurysmatic subarachnoid hemorrhage (aSAH) reduces cerebral perfusion and causes delayed cerebral ischemia. Although endovascular spasmolysis shows convincing angiographic results, patients often do not improve in outcome. Delayed recognition of CVS contributes substantially to this effect. Therefore, this study aimed to confirm established and to identify unknown risk factors for CVS, which can be used for risk stratification.

Methods In this monocentric, retrospective cohort study of 853 patients with aSAH, we compared demographics, clinical, and radiographic parameters at the time of aneurysm occlusion between patients who developed CVS and those who did not. Significant cohort differences were included as predictors in a multivariate analysis to address confounding. Logistic regression models were used to determine odds ratios (ORs) for the presence of CVS for each predictor.

Results Of the 853 patients treated with aSAH, 304 (32%) developed CVS. In the univariable analysis, CVS was significantly associated with young age, female sex, aneurysm location, modified Fisher score, Barrow Neurological Institute (BNI) score, and surgical interventions. In the multivariable regression analysis, we identified BNI score (OR 1.33, 95% CI 1.11 to 1.58, p=0.002), decompressive craniectomy (OR 1.93, 95% CI 1.22 to 3.04, p=0.005), and aneurysm clipping (OR 2.22, 95% CI 1.50 to 3.29, p<0.001), as independent risk factors.

Conclusions Young female patients with high BNI scores who undergo surgical interventions are more likely to develop CVS and should therefore be monitored most intensively after aneurysm occlusion.

  • Aneurysm
  • Angiography
  • Statistics
  • Subarachnoid
  • Stroke

Data availability statement

Data are available upon reasonable request. All source data are stored at the Klinikum rechts der Isar, Technical University Munich. We invite parties interested in collaboration and data exchange to contact the corresponding author directly.

https://doi.org/10.1136/jnis-2023-020649

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    Data availability statement

    Data are available upon reasonable request. All source data are stored at the Klinikum rechts der Isar, Technical University Munich. We invite parties interested in collaboration and data exchange to contact the corresponding author directly.

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    Footnotes

    • Twitter @schwarting91

    • Contributors All authors made substantial contributions to the study conception, design, data acquisition, data analysis, and data interpretation. DT, A-KJ, CA, and MW acquired data. JB performed statistical analysis. JS and TB-B drafted the manuscript and all the other authors revised it critically and made substantial contributions. JS acted as the guarantor. All authors approved the final version to be published.

    • 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.

    • 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.