gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Early vasospasm after aneurysmal subarachnoid hemorrhage predicts the occurrence and severity of symptomatic vasospasm and delayed cerebral ischemia

Meeting Abstract

  • Ramazan Jabbarli - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Germany; Klinik für Neurochirurgie, Universitätsklinikum Essen, Germany
  • Matthias Reinhard - Klinik für Neurologie, Universitätsklinikum Freiburg, Germany
  • Roland Roelz - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Germany
  • Mukesch Shah - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Germany
  • Astrid Weyerbrock - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Germany
  • Vera Van Velthoven - Klinik für Neurochirurgie, Universitätsklinikum Freiburg, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.11.02

doi: 10.3205/16dgnc291, urn:nbn:de:0183-16dgnc2915

Veröffentlicht: 8. Juni 2016

© 2016 Jabbarli et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Cerebral vasospasm usually develops several days after subarachnoid hemorrhage (SAH) and is generally acknowledged as a strong outcome predictor. In contrast, much less is known about the nature and eventual consequences of early angiographic vasospasm (EAVS) seen on admission digital subtraction angiography (DSA). We aimed to identify the risk factors and clinical impact of EAVS after SAH.

Method: 531 SAH patients with admission DSA performed within 72 hours after the bleeding event were selected from a comprehensive database containing all consecutive SAH patients treated at our institution between January 2005 and December 2012. Predictors of EAVS, as well as associations between EAVS and delayed vasospasm-related complications and unfavorable outcome (defined as modified Rankin scale >3) were evaluated in univariate and multivariate analyses.

Results: EAVS was seen on 60 DSAs (11.3%) and was independently correlated with late symptomatic vasospasm requiring intra-arterial spasmolysis (odds ratio (OR) =5.24, p<0.0001), angioplasty (OR=2.56, p=0.015) and repetitive endovascular vasospasm treatment (OR=4.71, p<0.0001). EAVS also increased the risk for multiple versus single territorial infarction on the follow-up computed tomography scan(s) (OR=2.04, p=0.047) and independently predicted unfavorable outcome (OR=2.93, p=0.008). The presence of radiographic signs suspicious for fibromuscular dysplasia were independently associated with the occurrence of EAVS (OR=2.98, p=0.026) and the need for repetitive endovascular vasospasm treatment (OR=3.95, p=0.019).

Conclusions: In view of the strong correlation with delayed cerebral vasospasm and its ischemic complications, EAVS can be considered an alerting signal for severe symptomatic vasospasm. Therefore, more attention should be paid to the presence of EAVS on admission DSA.