Correlation of Vasospasm Vascular Territory and Severity with Clinical Outcomes in Aneurysmal Subarachnoid Hemorrhage: A Cohort Study of 406 Patients. (16th November 2020)

• Record Type: Journal Article
• Authors: Cole, Tyler S; Gandhi, Sirin; Cavallo, Claudio; Catapano, Joshua; Albuquerque, Felipe; Ducruet, Andrew F
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_311
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Although the effects of vasospasm and delayed cerebral ischemia are acknowledged in subarachnoid hemorrhage, no studyhas evaluated the effect of vasospasm territory and clinical outcomes. METHODS: The Barrow Rupture Aneurysm Trial (BRAT) data was analyzed in a post-hoc fashion. 406 surgically or endovascularly treated patients were included in this cohort between March 2003 and January 2007. Patients who had vasospasm within this cohort were selected for angiographic review. Variables collected included day of onset of vasospasm, vessel and subsegment of vasospasm, intraarterial treatment given, and vasospasm severity. Severity was defined by reduction in angiographic measure of the vessel relative to pre-vasospasm caliber. Up to one-third reduction was considered mild, up to two-third reduction was considered moderate, and further reduction was considered severe. Modified Rankin Scale (mRS) was used as an outcome, with mRS > 2 considered unfavorable. RESULTS: On adjusted analysis, any left-sided vasospasm was significantly associated with poor discharge outcome (OR 2.37, CI 1.25-4.66, P = . 01). At six months, excluding patients who were deceased or lost to follow up, the most significant vasospasm association was vasospasm in either ACA territory (OR 3.73, CI 1.22-11.65, P = . 021) or left ICA vasospasm (OR 6.02, CI 1.08-37.47, P = . 045). There was no statistically significant association with proximal segment (A1, P1) vs distal segment (A2, P2) vasospasm. However, 9/9 patients with P2 vasospasm had an unfavorable discharge status. Incorporating vasospasm variables into a predictive model, we were able to achieve an AUC of 0.88 and a net improvement in reclassification of 10.22% ( P = .02) compared to the validated SAHIT model (AUC 0.75) in evaluating 6 month mRS. CONCLUSION: In aneurysmal subarachnoid hemorrhage, we observe that any left-sided vasospasm is associated with an increased risk of unfavorable mRS at discharge. At 6 months, we observe that either ACA vasospasm or left ICA vasospasm was associated with unfavorable mRS. Although not statisicially significant, 9/9 patients with P2 vasospasm had an unfavorable discharge status. Incorporating vasospasm variables can significantly improve aneurysmal SAH outcome prognostication.