Article
Angiographic pattern of cerebral vasospasm and its impact on the clinical course of patients with spontaneous subarachnoid haemorrhage and cerebral vasospasm
Das Muster angiographischer Vasospasmen und deren Einflussauf den weiteren klinischen Verlauf von Patienten mit spontaner Subarachnoidalblutung und zerebralen Vasospasmen
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Authors
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Claudia Ditz
- Universitätsklinikum Schleswig-Holstein, Neurochirurgie, Lübeck, Deutschland
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Jan Leppert
- Universitätsklinikum Schleswig-Holstein, Neurochirurgie, Lübeck, Deutschland
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Alexander Neumann
- Universitätsklinikum Schleswig-Holstein, Neuroradiologie, Lübeck, Deutschland
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Hannes Schacht
- Universitätsklinikum Schleswig-Holstein, Neuroradiologie, Lübeck, Deutschland
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Jan Gliemroth
- Universitätsklinikum Schleswig-Holstein, Neurochirurgie, Lübeck, Deutschland
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Volker M. Tronnier
- Universitätsklinikum Schleswig-Holstein, Neurochirurgie, Lübeck, Deutschland
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Jan Küchler
- Universitätsklinikum Schleswig-Holstein, Neurochirurgie, Lübeck, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Cerebral vasospasm (CVS) is a common complication of spontaneous subarachnoid hemorrhage (sSAH) and associated with delayed cerebral ischemia (DCI) and unfavourable outcome. Only poor data exist about the detailed angiographic pattern of CVS and its impact on the further clinical course. This study aimed to analyze detailed characteristics of angiographic CVS, identifying patients with a potential higher risk for an unfavorable clinical course.
Methods: A retrospective single-center study of sSAH patients admitted in a 6-year period. Patients with clinical suspicion of CVS who underwent cerebral angiography for confirmation of CVS were included. Clinical and demographic data as well as outcome parameters were collected. Angiographic characteristics (e.g. distribution and severity of CVS, intra-arterial treatment) were analyzed.
Results: 85 patients with a median age of 52 years were assessed. A total of311 arterial territories in 85 angiographies demonstrated angiographic CVS. ACA was the most common site of angiographic CVS (42.1 %), followed by MCA (26.7 %). In 29 angiographies (34%) severe CVS was found in more than 3 vessels and a bilateral pattern has been found in 53 cases (62%). Older age (3.24 [1.30-8.07], p = 0.012) and the onset of neurological deficits prior to DSA were identified as significant risk factors for CVS-related infarction (OR 22.67, p = 0.015). Poor functional outcome was associated with older age (OR 3.24, p = 0.023) and poor WFNS grade (OR 3.64, p = 0.015). Multivariate analysis of the angiographic characteristics did not reveal any risk factors for poor functional outcome. Concerning the occurrence of CVS-related infarction, we identified the distal localization of CVS as a significant risk factor (OR 2.89, p=0.026).
Conclusion: Angiographic CVS after sSAB shows a specific distribution pattern in favor of ACA and ACM with a majority of 2-3 affected vessels, often bilaterally. Patients exhibiting distal CVS localization seem to be at higher risk for the occurrence of CVS-related infarction and should be observed very closely. However, the majority of angiographic characteristics did not allow conclusions about the functional outcome nor the occurrence of CVS-related infarction in sSAH patients with CVS.
