The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm

Abstract

Vasospasm and re-bleeding after subarachnoid hemorrhage from ruptured intracranial aneurysm are devastating complication that can severely affect the outcome of the patients. We are presenting a series of total number of 224 patients treated and operated at our Department due to subarachnoid hemorrhage, out of which certain number developed vasospasm and re-bleeding. We are evaluating the effect of these complications on the outcome of the patients according to the Glasgow Outcome Scale at the day of discharge. In our experience both vasospasm and ReSAH can significantly influence the outcome of patients with subarachnoid hemorrhage from ruptured intracranial aneurysm.

RETRACTED: ANXA3 Silencing Ameliorates Intracranial Aneurysm via Inhibition of the JNK Signaling Pathway

“…Intracranial aneurysm (IA) is a bulge or ballooning of the cranial blood vessels in the brain, which can cause severe complications including subarachnoid hemorrhage, vasospasm, and re-bleeding that might lead to death 1 . The spontaneous rupture of IAs is a substantial cause of morbidity and mortality in IA patients, and seriously influences the treatment of the patients with IA 2, 3. In the general population, women with fibromuscular dysplasia have a higher risk for IA 4 .…”

Clinical Burden of Angiographic Vasospasm and Its Complications After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

“…Five [ 22 , 28 , 30 , 36 , 40 ] of six comparative studies and eight [ 45 – 47 , 57 , 61 , 69 , 77 , 78 ] of nine regression-based studies found that patients with angiographic VSP, TCD-defined VSP, cerebral VSP, or VSP-related DCI post aSAH had poorer neurological outcomes, measured by the GOS and GOS-E, both at discharge and at follow-up, compared with those without angiographic VSP, TCD-defined VSP, cerebral VSP, or VSP-related DCI.…”

“…Among the comparative studies (ESM Tables S15, S16), one small (< 55 patients) prospective study found that patients with VSP-related DCI, compared to those without, had significantly higher odds of poor neurological status (GOS < 4) at discharge (OR 5.4, 95% CI 1.2–24; p = 0.03), which persisted 3-months after aSAH (odds ratio [OR] 10, 95% confidence interval [CI] 2.0–49; p < 0.01) [ 22 ], and another reported that aSAH patients with angiographic VSP had significantly worse neurological outcomes on the GOS-E scale at 6 months ( p = 0.01 vs. those without angiographic VSP) [ 40 ]. Retrospective studies found that aSAH patients with cerebral VSP had significantly poorer neurological outcomes at discharge, as assessed by the GOS ( p < 0.001 vs. no cerebral VSP) ( n = 224) [ 28 ], and that severe TCD-defined VSP predicted poorer neurological outcomes (GOS 1–3) at 3, 6, and 12-months post aSAH compared with mild or moderate TCD-defined VSP (all p < 0.01) ( n = 142) [ 36 ]. Similarly, aSAH patients with angiographic VSP had poorer GOS-E scores at discharge ( p = 0.01 vs. no angiographic VSP) but not at 3–6 months follow-up, whereas patients with DCI had poorer GOS-E scores at both discharge and at 3–6 months of follow-up ( p < 0.001 and p = 0.002 vs, no DCI, respectively) ( n = 138) [ 30 ].…”

Evaluation of unruptured aneurysm scoring systems and ratios in subarachnoid hemorrhage patients with multiple intracranial aneurysms

“…On the other hand, Baumann et al . [ 2 ] reported vasospasm as the common complication in their series (44%), Filipce and Caparoski[ 7 ] found also that patients with vasospasm have less good outcomes compared to those without vasospasm (7.10% vs. 54%, P < 0.001), and Sharma et al . [ 22 ] found vasospasm or hydrocephalus such as factors associated with unfavorable outcomes ( P = 0.04).…”