gms | German Medical Science

Objective: The current study was designed to evaluate the influence of the distal VS on the clinical and radiological outcome after SAH.

Method: 61 patients were prospectively included within 48h after the ictus. The degree of cerebral vasospasm (VS) was evaluated based on a baseline digital subtraction angiography (DSA) and a follow-up DSA on day 8. Delayed cerebral infractions (DIL) were diagnosed in CT scans at least 10 days after the bleeding event. The blood volume was quantified by the Fisher Scale, the modified Fisher Scale and the Hijdra Scale. The clinical outcome was evaluated by the Glasgow Coma Scale, the modified Rankin Scale, the Glasgow Outcome Scale Extended and the National Institute of Health Stroke Scale.

Results: 38 patients developed a moderate/severe proximal VS, 21 patients a moderate/severe distal VS. 15 patients (24.6%) developed 24 DIL in CT scans 10 days after the initial bleeding event. 2 DIL (8,3%) were located in areas with isolated moderate/severe distal VS. In 25 cases (40.98%) a moderate or severe proximal VS was diagnosed in absence of any DIL. This was also the case in 10 patients (16.39%) with moderate/severe distal VS. The degree of proximal and distal VS of the isolated cerebral arteries showed significant higher values in vascular territories with a corresponding DIL compared to the territories with no DIL (proximal: 2.15 ± 0.93 vs. 3.09 ± 0.53, p < 0.001; distal: 1.94 ± 0.9 vs. 2.88 ± 1.12, p < 0.001; Mann-Whitney U-test). The degree of the overall proximal, distal and global VS also showed significant higher values in patients with DIL compared to patients with no DIL (proximal: 2.54 ± 0.69 vs. 3.33 ± 0.49, p = 0.0002; distal: 1.96 ± 0.87 vs. 3.13 ± 0.99, p = 0.0003, global: 2.67 ± 0.67 vs. 3.6 ± 0.51, p < 0.0001, Mann-Whitney U-test). The overall degree of the proximal VS showed a significant correlation with the overall distal VS in the same patient (p = 0.0001) while no significant correlation was detectable when analyzing the different arteries separately.

Conclusions: The results indicate a relevant influence of distal VS on the outcome after aSAH and demonstrate the importance of quantifying the VS in all sections of the cerebral vessels. Furthermore the data implicates that the occurrence of cerebral VS should not be considered as a pathophysiological process of isolated cerebral arteries but rather as a reflection of the general susceptibility of the patient's brain for permanent ischemic damage.