gms | German Medical Science

Objective: Delayed cerebral vasospasm (dCVS) is a feared complication of aneurysmal subarachnoid hemorrhage (SAH). Although dCVS is well studied, there is little information on acute phase vasospasm and vasospasm occurring after treatment of intracranial aneurysms, whether ruptured or not. The aim of the current study is to make use of our hybrid operating suite in which angiographies are performed immediately after surgical or endovascular occlusion of aneurysms to assess the impact of intraoperative cerebral vasospasm (iCVS).

Method: Consecutive patients treated in our hybrid operating suite for intracranial aneurysms, both ruptured and unruptured, were included. Angiograms were reviewed and spasm severity was classified with respect to reduction in vessel diameter. Mild vasospasm was defined as a reduction in vessel diameter of 10-30 %; moderate, 30-50 %; and severe vasospasm, >50 %. Chi² test was used with a significance level of p<0.05. Correlations between iCVS and other factors were investigated.

Results: Seventy-seven patients (44 women, 33 men) out of 109 patients presented with acute SAH and 32 patients (23 women and 9 men) underwent aneurysm occlusion. Seventeen (22 %) of 77 patients presenting with acute SAH had evidence of acute vasospasm (within 72 h after SAH ictus). In 16 out of 17 (94.1 %) patients, this vasospasm was observed immediately after treatment and was therefore termed iCVS. Eleven (30 %) of 36 patients undergoing clipping and 5 (14 %) of 36 patients with endovascular aneurysm occlusion had iCVS (p = 0.07). Patients presenting with acute SAH had a higher incidence of iCVS than patients undergoing elective aneurysm treatment (p = 0.02). Only one patient (3 %) had iCVS in the elective treatment group whereas 16 (20 %) had iCVS after SAH. The incidence of dCVS, delayed ischemic neurological deficits (DNDs), and poor outcome in patients presenting with iCVS during surgical treatment of ruptured aneurysms was 56 % (p = 0.001), 63 % (p = 0.02), and 38 % (p = 0.14), respectively.

Conclusions: Postinterventional vasospasm is a common finding in patients with SAH but rare in patients with unruptured aneurysms. In patients with SAH, the rate of dCVS is higher in patients with iCVS. The implementation of early postinterventional angiographic imaging in a hybrid operating suite might facilitate its detection and potentially identify patients who may have an increased risk of delayed ischemia.