Vasospasm-Related Death after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Case–Control Study

Abstract

Background: Vasospasm after the rupture of an intracranial aneurysm is a frequent phenomenon and is the main cause of morbidity and mortality in patients who have survived intracranial hemorrhage and aneurysm treatment. We analyzed the diagnosis and management of patients with aneurysmal subarachnoid hemorrhage who eventually died from ischemic brain damage due to vasospasm. Methods: Between January 2007 and December 2021 (15 years), a total of 1064 patients were diagnosed with an aneurysmal intracranial hemorrhage in a single comprehensive neurovascular center. Vasospasm was diagnosed in 408 patients (38.4%). A total of 187 patients (17.6%) died within 90 days of the aneurysm rupture. In 64 of these 187 patients (33.7%), vasospasm was considered to be the cause of death. In a retrospective analysis, demographic and clinical data for patients without, with non-fatal, and with fatal vasospasm were compared. The patients with fatal vasospasm were categorized into the following subgroups: “no diagnosis and treatment” (Group a), “delayed diagnosis” (Group b), “cardiovascular complications” (Group c), and “vasospasm-treatment complications” (Group d). Results: Among the patients with fatal vasospasm, 31 (48.4%) were assigned to group a, 26 (40.6%) to group b, seven (10.9%) to group c, and none (0%) to group d. Conclusion: The early recognition of severe posthemorrhagic vasospasm is a prerequisite for any treatment and requires routine diagnostic imaging in all unconscious patients. Aggressive endovascular vasospasm treatment may fail to prevent death but is infrequently the cause of a fatal outcome.

Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study

“…DACAA rupture is frequently associated with intracerebral hematoma in the frontal lobe and may be localized to either side ( 15 ). In a study by Khanafer et al ( 18 ), 50 of 1,064 (4.7%) cases of subarachnoid hemorrhage due to aneurysm rupture were found to directly result from ruptured DACAAs. In this subgroup, 15 of the patients (30%) were symptomatic because of vasospasm ( 18 ).…”

“…In a study by Khanafer et al ( 18 ), 50 of 1,064 (4.7%) cases of subarachnoid hemorrhage due to aneurysm rupture were found to directly result from ruptured DACAAs. In this subgroup, 15 of the patients (30%) were symptomatic because of vasospasm ( 18 ). Given the elevated likelihood of rupture and bleeding, treatment is always recommended for incidental DACAAs, despite their small size.…”

The impact of pre-ictal statin use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage

“…Vasospasm after SAH is common and diagnosed in up to 70% on angiography, whereas symptomatic VS with neurologic deterioration occurs in about 30% [9]. Vasospasm is a feared complication to aSAH and is associated with poorer outcome [25]. The pathophysiology of VS is a complex cascade of events that is not yet fully understood.…”