Prediction and outcomes of cerebral vasospasm in ischemic stroke patients receiving anterior circulation endovascular stroke treatment

Abstract

Background and purpose: Vasospasm is a common complication of endovascular therapy (EVT). There is a lack of understanding of risk factors for periprocedural vasospasm. Here, we aimed to identify factors associated with vasospasm in patients with acute ischemic stroke who undergo EVT. Methods: We conducted a retrospective single-center analysis of patients receiving EVT for anterior circulation vessel occlusion between January 2015 and December 2021. Patients were excluded if they showed signs of intracranial atherosclerotic disease (ICAD) or if they underwent intra-arterial thrombolysis. Study groups were defined as patients developing vasospasm during EVT (V+) and patients who did not (V−). The study groups were compared in univariable analysis. Multivariable regression models were developed to predict the patient’s risk for developing vasospasm based on pre-identified potential prognostic factors. The secondary endpoint was clinical outcome defined as the modified Rankin Scale (mRS) difference between pre-stroke mRS and discharge mRS (delta mRS) and likelihood of successful reperfusion (TICI 2b/3). Results: In total, 132/1768 patients (7.5%) developed vasospasm during EVT. Vasospasm was more likely to occur in EVT with multiple thrombectomy attempts and after several stent retriever maneuvers. Factors associated with developing vasospasm were younger age (OR = 0.967, 95% CI = 0.96–0.98) and lower pre-stroke mRS (OR = 0.759, 95% CI = 0.63–0.91). The prediction model incorporating patient age, pre-stroke mRS, stent retriever thrombectomy attempts, and total attempts as prognostic factors was found to predict vasospasm with good accuracy (AUC = 0.714, 95% CI = 0.709–0.720). V+ patients showed higher median (IQR) delta mRS (2 (1–4) vs 2 (1–3); p = 0.014). There was no difference in successful reperfusion (TICI 2b-3) between those with or without vasospasm. Conclusion: Vasospasm was a common complication in EVT affecting younger and previously healthy patients. Presence of vasospasm did not reduce the likelihood of successful reperfusion. As independent predictors, patient age, pre-stroke mRS, thrombectomy maneuvers, and stent retriever attempts predict the occurrence of vasospasm during EVT with good accuracy.

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

“…Female respondents were underrepresented with 22%, which reflects the current status of female underrepresentation in neurointervention and is therefore not to be seen as a study bias [14]. It has been shown in a Western-European cohort, that intracranial vasospasm during EVT for acute stroke was present in the range of 5-10% and was more likely to occur in younger patients [6]. The detection rate among respondents did not differ regarding study groups or geographical background of the NI.…”

“…Vasospasm is more likely to occur in younger stroke patients as well as in EVT with multiple thrombectomy attempts [6]. While vasospasm during EVT is considered as non-serious and a transient complication by some authors [7], others discuss vasospasm as a potential cause for stroke recurrence [8].…”

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

“…14 It has been shown in a Western-European cohort that intracranial vasospasm during EVT for acute stroke was present in the range of 5%-10% and was more likely to occur in younger patients. 6 The detection rate among respondents did not Open access differ regarding study groups or geographical background of the NI. NIs practising in Asia more often added vasodilators routinely to their flushes.…”

“…5 Vasospasm is more likely to occur in younger patients with stroke as well as in EVT with multiple thrombectomy attempts. 6 While vasospasm during EVT is generally considered as non-serious and a transient complication by many authors, 7 others discuss vasospasm as a potential cause for extended infarction after EVT, difficulties in further EVT manoeuvres with 'snagging' of stent retrievers or stroke recurrence. 8 The clinical relevance of vasospasm as a complication during EVT remains WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Vasospasm occurs in up to 20% of endovascular stroke treatments (EVTs), in younger patients and might lead to extended infarctions.…”