gms | German Medical Science

Objective: To evaluate prospectively the clinical outcome of a population of patients presenting with aneurysmal subarachnoid haemorrage in two neurosurgical centers not using oral nimodipine as a systematic prophylaxis but aggressive therapeutic treatment of vasospasm (controlled hypertension +/- angioplasty).

Methods: We evaluated 186 patients admitted consecutively with aSAH from 2013 to 2016. Parameters recorded were age, gender, WFNS grade, modified Fisher score, treatment received for the ruptured aneurysm (surgical versus endovascular) and prevalence of vasospasm using clinical scales. Outcome was assessed after 1 year of follow-up using the modified Rankin scale (mRs).

Results: Vasospasm was observed in 35% (N=66) of patients suffering aSAH. Among patients presenting a vasospasm, 39% (N=26) received medical treatment only (observation in the ICU and controlled hypertensive therapy), 53% (N=35) received medical combined with endovascular treatment, (balloon angioplasty: 28%, chemical angioplasty: 60%, both: 11%. No significant difference was present concerning the mortality/morbidity in patients treated by angioplasty versus those treated with controlled hypertension only.

High Modified Fisher scores (III-IV) were associated with vasospasm and low Modified Fisher scores (I-II) against it (two-sided Chi2 analysis, p= 0.01). GCS at admission and WFNS were not predictive for vasospasm occurrence. Patients with EVD placement were more represented in the vasospasm group (p=0.0009), which is also true for patients with VPD shunting (p=0.0002). Mortality and morbidity were not different between vasospasm and vasospasm-free patients. A bad clinical outcome (mRS³3) in the first 1 year FU was respectively found in 9 patients (13%) in the vasospasm group and in 17 patients (14%) in the vasospasm-free group.

Conclusion: The occurrence of a clinically relevant vasospasm is not associated with worse outcome when its treatment includes controlled hypertension and endovascular angioplasty. Compared to data reported in the literature, clinical outcome of this cohort managed without oral nimodipine seems to be comparable to a population of aSAH whom treatment included a preventive therapy of vasospasm with oral nimodipine. Our results have to be confirmed by new controlled randomized trial comparing contemporary vasospasm management involving controlled hypertension and endovascular angioplasty (balloon or chemical) with or without oral nimodipine as a preventive therapy.