Does Treatment Modality of Intracranial Ruptured Aneurysms Influence the Incidence of Cerebral Vasospasm and Clinical Outcome?

Abstract

Background: Cerebral vasospasm is the most common cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). This study is designed to determine whether the incidence of symptomatic vasospasm and the overall clinical outcome differ between patients treated with surgical clipping compared with endovascular obliteration of aneurysms. Methods: In this prospective study, 98 patients with aneurysmal SAH were treated. Seventy-two patients underwent surgery and clipping and 26 had coil embolization. The incidence of symptomatic vasospasm, permanent neurologic deficit due to vasospasm and clinical outcome were analyzed. Patients with better clinical and radiological grades (World Federation of Neurological Surgeons grades I–III and Fisher grades I–III) were analyzed separately. Results: Symptomatic vasospasm occurred in 22% of the patients; 25% in the surgical group and 15% in the endovascular group. Nine percent of the patients in the surgical group and 7% in the endovascular group suffered ischemic infarction with permanent neurological deficit. These differences did not reach statistical significance (p = 0.42). For patients with better clinical and radiological grades, no significant difference was found for the rate of symptomatic vasospasm; 23% in the surgical and 12% in the endovascular group (p = 0.49). The overall clinical outcome was comparable in both groups, with no difference in the likelihood of a Glasgow Outcome Scale score of 3 or less (15% in the surgical and 16% in the endovascular group; p = 0.87). The same results for outcome were obtained for the subgroup of patients with better clinical grades on admission. Conclusion: Symptomatic vasospasm and ischemic infarction rate seem comparable in both groups, even for patients with better clinical and radiological admission grades. There is no significant difference in the overall clinical outcome at the long-term follow-up between both groups.

Incidence of Vasospasm, Outcome, and Quality of Life after Endovascular and Surgical Treatment of Ruptured Intracranial Aneurysms: Results of a Single-Center Prospective Study in Switzerland

“…Only four studies were prospective [5,7,9,11]. In five out of seven studies including 758 patients undergoing clipping and 249 patients undergoing coiling, no differences in terms of outcome (GOS) could be demonstrated [5,7,[9][10][11].…”

“…The authors demonstrated that patients with better clinical grades (WFNS I-III) at hospital admission were less to suffer symptomatic CVS when treated with endovascular techniques compared with surgical treatment. More recently, Dehdashti et al [11] reported the results of a study in 72 patients, an incidence of symptomatic CVS of 25% in patients undergoing clipping and 15% in patients undergoing coiling of ruptured aneurysms. The authors found no statistical significance comparing the neurological deficits in both groups.…”

“…The analysis [5][6][7][9][10][11][12]. Six studies evaluated the outcome based on the GOS exclusively [5,7,[10][11][12]: one study included additionally neuropsychological assessment [9] and one reported the outcome in terms of mRS [6].…”

“…Moreover, differences in outcome between patients undergoing endovascular and surgical treatment have not been extensively studied [5][6][7][8][9][10][11][12]. In terms of comparison of quality of life between patients treated with endovascular and surgical techniques, only one study has been published so far [13].…”

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

“…Se estima que en un 5-9% de los pacientes con HSA que mueren o permanecen con discapacidad severa el vasospasmo es la causa [2][3][4] .…”