gms | German Medical Science

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.