Article Figures & Data
Figures
- Fig 1.
Repeat angiograms in refractory cerebral vasospasms. Repeat angiograms (red arrows: proximal spastic vessels; blue arrows: distal spastic vessels) in a 41-year-old woman with a ruptured anterior communicating artery aneurysm initially treated with coil embolization. On day 8 after the ictus, the patient presented with hemiparesis on the left side. A, ICA angiogram, anteroposterior view, shows vasospasm of the right-sided M1 and A1/A2 segments. B, ICA angiogram of the same patient after nimodipine infusion demonstrates reduced vasospasm of the M1 and A1/A2 segments, with improved perfusion of both the proximal and distal arteries. C–M, Corresponding angiograms of the anterior circulation (C, D, G, H, L, M) and posterior circulation (E, F, I, K) in the same patient during the CVS period from day 9 to day 13. Images on the right side show the effect after IAN. Note the effect of nimodipine infusion on the vessel diameter (white arrows).
Tables
- Table 1:
Characteristics of patients with cerebral vasospasm treated with ≥3 interventions compared with those treated with ≤2 interventions
Characteristics Group I: 1 or 2 Interventions Group II: 3–6 Interventions All Patients P Value Cases (No.) (%) 52 (63) 31 (37) 83 (100) Age (mean) (range) (yr) 55.5 ± 11.3, 24–75 52.1 ± 8.6, 34–77 54.2 ± 10.5, 24–77 .158 Women (No.) (%) 42 (81) 24 (77) 66 (80) .782 Hunt and Hess grade (No.) (%) HH scale ≤2 27 (52) 11 (36) 38 (46) .176 HH scale ≥3 25 (48) 20 (64) 45 (54) .176 Fisher grade 3 (No.) (%) 46 (89) 30 (97) 76 (92) .248 GCS at admission Mild 21 (41) 13 (42) 34 (42) .999 Moderate 8 (16) 9 (29) 17 (21) .162 Severe 22 (43) 9 (29) 31 (38) .245 Aneurysms location (No.) (%) Anterior 33 (64) 21 (68) 54 (65) .813 Posterior 19 (36) 10 (32) 29 (35) .813 Multiple aneurysms 17 (33) 13 (42) 30 (36) .481 Aneurysm obliteration Clipping 19 (36) 5 (16) 24 (29) .078 Coiling 33 (64) 26 (84) 59 (71) .078 Intracerebral hemorrhage 7 (14) 9 (29) 16 (20) .15 Intra-arterial spasmolysis No. of treatments (mean) (range) 78 (1.5 ± 0.5, 1–2) 132 (4.3 ± 1.6, 3–10) 210 (2.5 ± 1.7, 1–10) <.001 No. of vessel segments treated (mean) (range) 152 (2.9 ± 1.5, 1–6) 298 (9.6 ± 6.6, 4–40) 450 (5.4 ± 5.3, 1–40) <.001 No. of vascular territories (mean) (range) 85 (1.6 ± 0.7, 1–3) 72 (2.3 ± 0.8, 1–3) 157 (1.9 ± 0.8, 1–3) <.001 PTA (No.) (%) 9 (17) 17 (55) 26 (31) .001 Vessel dissections (No.) (%) 1 (2) 5 (16) 6 (7) .03 Follow-up (mean) (median) (range) (mo) 12 ± 8.7, 10, 1–24 10 ± 6.3, 9, 2–22 11 ± 7.9, 10, 1–24 .316 Outcome Group I: 1 or 2 Interventions Group II: 3–6 Interventions All Patients P Value mRS ≤2 at discharge (No.) (%) 16 (31) 5 (16) 21 (25) .193 mRS ≤2 (good outcome) at last FU (No.) (%) 31 (61) 18 (58) 49 (60) .821 mRS 3–5 (poor outcome) at last FU (No.) (%) 13 (26) 4 (13) 17 (21) .262 Persistent disabilities requiring constant nursing care (mRS 4 and 5) (No.) (%) 4 (8) 3 (10) 7 (9) .999 Mortality (No.) (%) 7 (14) 9 (29) 16 (20) .149 Infarcts in eloquent brain areas (No.) (%) 18 (37) 17 (55) 35 (44) .165 Brain infarcts (No.) (%) 26 (52) 23 (74) 49 (61) .062 Note:—FU indicates follow-up.
Predictors for Good Outcome (mRS <2) Univariable Analyses (OR) (95% CI) P Value Multivariable Analyses (OR) (95% CI) P Value No. of treatments 0.995 (0.77–1.29) .969 Male sex 1.816 (0.57–5.75) .31 Age (yr) 0.961 (0.92–1.01) .084 Aneurysm, anterior location 0.749 (0.29–1.92) .547 Further aneurysms 1.161 (0.46–2.94) .752 Aneurysm obliteration, clip 0.568 (0.22–1.49) .249 HH scale ≤2 7.75 (2.69–22.33) <.001 4.72 (1.21–18.48) .026 Infarcts in eloquent areas 0.038 (0.01–0.13) <.001 0.074 (0.012–0.443) .004 No. of vessels treated 0.965 (0.89–1.05) .421 No. of vascular territories 0.594 (0.33–1.07) .082 PTA 0.7 (0.27–1.79) .458 Brain infarcts 0.069 (0.02–0.25) <.001 0.359 (0.04–3.08) .35 Age younger than 50 yr 1.66 (0.62–4.47) .316 Length of FU (mo) 1.01 (0.95–1.07) .72 Note:—FU indicates follow-up.
Risk Factors for Infarcts at Discharge Univariable Analyses (OR) (95% CI) P Value Multivariable Analyses (OR) (95% CI) P Value Age (yr) 0.99 (0.95–1.0) .646 Female sex 1.23 (0.41–3.77) .699 Aneurysm, anterior location 1.76 (0.70–4.45) .23 Further aneurysms 0.97 (0.39–2.43) .944 Aneurysm obliteration, clip 1.73 (0.62–4.85) .296 HH scale ≥3 3.14 (1.24–7.92) .016 3.35 (1.21–9.30) .02 No. of treatments 1.39 (1.00–1.94) .049 1.28 (0.66–2.46) .469 No. of vessels treated 1.17 (1.01–1.36) .034 0.93 (0.73–1.19) .561 No. of vascular territories 2.91 (1.49–5.64) .002 3.08 (1.30–7.30) .011 PTA 2.74 (0.95–7.90) .061 Age younger than 50 yr 0.81 (0.30–2.14) .807
Jump to section
Related Articles
Cited By...
- Stent Angioplasty for the Treatment of Cerebral Vasospasm: A Systematic Review and Meta-Analysis
- Risk Factors for Unfavorable Functional Outcome after Endovascular Treatment of Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage
- Distal cerebral vasospasm treatment following aneurysmal subarachnoid hemorrhage using the Comaneci device: technical feasibility and single-center preliminary results
- Levosimendan as a therapeutic strategy to prevent neuroinflammation after aneurysmal subarachnoid hemorrhage?
- Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study
- Distal Balloon Angioplasty of Cerebral Vasospasm Decreases the Risk of Delayed Cerebral Infarction