Impact of Basilar Artery Vasospasm on Outcome in Patients With Severe Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose-The purpose of the present study was to evaluate the impact of basilar artery (BA) vasospasm on outcome in patients with severe vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). Methods-Sixty-five patients with clinically suspect severe cerebral vasospasm after aSAH underwent cerebral angiography before endovascular treatment. Vasospasm severity was assessed for each patient by transcranial Doppler measurements, angiography, and 99m Tc-ethylcysteinate dimer single-photon emission computed tomography (ECD-SPECT) imaging. Percentage of BA narrowing was calculated in reference to the baseline angiogram. Results-BA narrowing Ն25% was found in 23 of 65 patients, and delayed brain stem (BS) hypoperfusion, as estimated by ECD-SPECT, was found in 16. Fourteen of 23 patients with BA narrowing Ն25% experienced BS hypoperfusion, whereas only 2 of 42 patients with Ն25% BA narrowing experienced BS ischemia (PϽ0.001). Stepwise logistic regression after adjusting for age with Hunt and Hess grade, Fisher grade, hydrocephalus, and aneurysmal location as covariables revealed BA narrowing Ն25% and delayed BS hypoperfusion to be significantly and independently associated with unfavorable 3-month outcome (Pϭ0.0001; odds ratio, 10.1; 95% CI, 2.5 to 40.8; and Pϭ0.007; odds ratio, 13.8, 95% CI, 2.18 to 91.9, respectively). Conclusions-These findings suggest for the first time that BA vasospasm after aSAH is an independent and significant prognostic factor associated with poor outcome in patients with severe cerebral vasospasm requiring endovascular therapy. Further study should be done to evaluate the role of interventional therapy on outcome in patients with posterior circulation vasospasm.

The impact of surgical timing on the management of aneurysms with acute hydrocephalus after aneurysmal subarachnoid hemorrhage

“…severe vasospasm after aSAH (15). Collectively, these studies highlight the fact that apart from hydrocephalus, more variables are involved in the outcomes of SAH patients.…”

Vertebrobasilar Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Review

“…In essence, delayed brainstem ischemia was found to be associated with higher bleeding intensity and elevated BA FVs, delayed ischemic neurological deficits, and so worse overall outcomes, which they posited could be secondary to significant compromise in flow through the perforating arteries emerging from the basilar artery at a 90% angle that serve as the main source of blood flow to the brainstem. In an additional research of Sviri et al [42] BA narrowing ≥25% was found in 23 of 65 patients, and delayed brain stem (BS) hypoperfusion, as estimated by ECD-SPECT, was found in 16. Fourteen of 23 patients with BA narrowing ≥25% experienced BS hypoperfusion, whereas only 2 of 42 patients with ≥25% BA narrowing experienced BS ischemia.…”

“…Fourteen of 23 patients with BA narrowing ≥25% experienced BS hypoperfusion, whereas only 2 of 42 patients with ≥25% BA narrowing experienced BS ischemia. Stepwise logistic regression after adjusting for age with Hunt and Hess grade, Fisher grade, hydrocephalus, and aneurysmal location as co-variables revealed BA narrowing ≥25% and delayed BS hypoperfusion to be significantly and independently associated with unfavorable 3-month outcome (P=0.0001; odds ratio, 10.1; 95% CI, 2.5 to 40.8; and P=0.007; odds ratio, 13.8, 95% CI, 2.18 to 91.9, respectively) and was an independent prognostic factor highly associated with an unfavorable outcome in aneurysmal SAH patients with clinically suspected severe VS, further suggesting that endovascular therapy intervention should be considered in the event of significant spasm in the VB system [41,42].…”

Targeting C/EBP homologous protein with siRNA attenuates cerebral vasospasm after experimental subarachnoid hemorrhage

“…Basilar artery was collected because it is close to bleeding site and is sensitive to subarachnoid hemorrhage (SAH). Studies have shown that BA vasospasm forms an independent factor of poor neurological outcome in patients with SAH (Sviri et al, 2006). In addition BA is relatively easy to be obtained and the body of BA is big enough for researching.…”