Multivariate Analysis of Predictors of Cerebral Vasospasm Occurrence After Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose-The role of type of treatment on cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage (SAH) has not been studied. Through multivariate analysis we determined the independent prognostic factors of the occurrence of symptomatic vasospasm following aneurysmal SAH in a study cohort of 244 patients undergoing either surgical or endovascular treatment. The prognostic factors of sequelae after aneurysmal SAH were studied as well. Methods-Symptomatic vasospasm was defined as the association of deterioration in a patient's neurological condition between 3 and 14 days after SAH with no other explanation and an increase in mean transcranial Doppler velocities of Ͼ120 cm/s. The prognostic factors were registered on admission and during the intensive care stay. , and secondary brain insults were associated with an increased risk of 6-month sequelae. Conclusions-Age Ͻ50 years, good neurological grade, and hyperglycemia were all associated with an increased risk of cerebral vasospasm whereas treatment was not. This provides a basis for future clinical prospective randomized trials comparing both treatments. Results-Symptomatic

Hyperglycemia in Aneurysmal Subarachnoid Hemorrhage: A Potentially Modifiable Risk Factor for Poor Outcome

“…The DCI occurs in approximately one third of aSAH patients, mostly between days 4 and 10 (Roos et al, 2000) and can progress to irreversible cerebral infarction with subsequent poor clinical outcome (Rosengart et al, 2007). Patients with hyperglycemia on admission or during the clinical course develop DCI and cerebral infarction more often than patients with normal blood glucose levels (Badjatia et al, 2005;Charpentier et al, 1999;Frontera et al, 2006;Juvela et al, 2005;Kruyt et al, 2008;Lanzino, 2005). The association between admission hyperglycemia and DCI was weaker than that of persistent hyperglycemia and DCI, and the association between admission glucose and DCI did not persist after multivariable assessment in several studies (Badjatia et al, 2005;Frontera et al, 2006;Juvela et al, 2005;Kruyt et al, 2008).…”

“…Besides neurologic complications, patients with aSAH often have cardiopulmonary and general medical complications that can influence outcome. Hyperglycemia in aSAH patients is common and associated with poor clinical outcome (Badjatia et al, 2005;Charpentier et al, 1999;Dorhout Mees et al, 2003;Frontera et al, 2006;Kruyt et al, 2008Kruyt et al, , 2009Lanzino et al, 1993). As treatment for hyperglycemia is available, it has attracted increasing attention as a target for intervention, although adequate and safe glycemic control is difficult to achieve in patients with aSAH.…”

Prognostic factors in patients underwent aneurysmal clipping surgery due to spontaneous subarachnoid hemorrhage

“…Taking the day of the hemorrhage as day 0, surgical intervals were defined either as immediate (day 0), early (days 1-3), intermediate (days [4][5][6][7][8][9][10][11][12][13][14] or late (days after 14).…”

Complications and Adverse Events Associated with Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms

“…However, when patients with Fisher grade 4 and Hunt and Hess grade V lesions were excluded, the difference between the treatment groups was no longer significant. Other authors 19,34,35 have not found an increased risk of vasospasm with endovascular therapy as well. They concluded that the type of treatment was not associated with an increased risk of cerebral vasospasm.…”