gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Intra-arterial spasmolysis and angioplasty for treatment of cerebral vasospasm after subarachnoid haemorrhage

Intra-arterielle Spasmolyse und Angioplastie für Behandlung von zerebralen Vasospasmen nach Subarachnoidalblutung

Meeting Abstract

  • presenting/speaker Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Mukesch Johannes Shah - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Roland Rölz - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Jürgen Beck - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV134

doi: 10.3205/19dgnc149, urn:nbn:de:0183-19dgnc1490

Published: May 8, 2019

© 2019 Jabbarli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Delayed cerebral ischemia (DCI) is strongly associated with poor outcome after subarachnoid hemorrhage (SAH). Cerebral vasospasm is major contributor to DCI and requires special attention. We aimed at analyzing the impact of vasospasm management on DCI and functional outcome of SAH.

Methods: Data from two observational cohorts with consecutive SAH patients treated between 2005 and 2012 were pooled. The impact of two institutional standards of conservative and endovascular vasospasm treatment (EVT) on the rates of DCI (new cerebral infarcts not visible on the post-treatment imaging) and unfavorable outcome (modified Rankin Scale >2) at 6 months follow-up was analyzed.

Results: The final analysis included 1057 SAH patients. There was no difference regarding demographic (age and sex), clinical (Hunt & Hess grades, acute hydrocephalus, treatment modality and infections) and radiographic (Fisher grades and aneurysm location) characteristics of the populations. However, there was a significant difference in the rate (24.4% (121/495) vs 14.4% (81/562), p<0.0001) and timing (first treatment on day 6 vs 8.9 after SAH, p<0.0001) of EVT. The rates of DCI (20.8% vs 29%, p=0.0001) and unfavorable outcome (44% vs 50.6%, p=0.04) were lower in the cohort with more frequent and early EVT. Multivariate analysis confirmed independent impact of EVT standard on DCI risk and outcome.

Conclusion: A preventive strategy utilizing a frequent and early EVT seems to reduce the risk of DCI in SAH patients and improve their functional outcome. We recommend prospective evaluation of the value of preventive EVT strategy on SAH.