Relationship between cerebral vasospasm vascular territory and functional outcome after aneurysmal subarachnoid hemorrhage

Authors

Tyler S. Cole, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Robert F. Rudy, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Erfan Faridmoayer, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Sirin Gandhi, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Claudio Cavallo, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Ashutosh P. Jadhav, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA neuropub@barrowneuro.org.

Document Type

Article

Abstract

BACKGROUND: Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) contributes significant morbidity and mortality after brain aneurysm rupture. However, the association between vascular territory of vasospasm and clinical outcome has not been studied. We present a hypothesis-generating study to determine whether the location of vasospasm within the intracranial circulation is associated with functional outcome after SAH. METHODS: A retrospective analysis of a prospective, intention-to-treat trial for aneurysmal SAH was performed to supplement trial outcomes with in-hospital angiographic imaging and treatment variables regarding vasospasm. The location of vasospasm and the position on the vessel (distal vs proximal) were evaluated. Modified Rankin scale (mRS) outcomes were assessed at discharge and 6 months, and predictive models were constructed. RESULTS: A total of 406 patients were included, 341 with follow-up data at 6 months. At discharge, left-sided vasospasm was associated with poor outcome (odds ratio (OR), 2.37; 95% CI, 1.25 to 4.66; P=0.01). At 6 months, anterior cerebral artery (ACA) vasospasm (OR, 3.87; 95% CI, 1.29 to 11.88; P=0.02) and basilar artery (BA) vasospasm (OR, 6.22; 95% CI, 1.54 to 27.11; P=0.01) were associated with poor outcome after adjustment. A model predicting 6-month mRS score and incorporating vasospasm variables achieved an area under the curve of 0.85 and a net improvement in reclassification of 13.2% (P<0.01) compared with a previously validated predictive model for aneurysmal SAH. CONCLUSIONS: In aneurysmal SAH, left-sided vasospasm is associated with worse discharge functional status. At 6 months, both ACA and BA vasospasm are associated with unfavorable functional status.

Keywords

Aneurysm, Angiography, CT Angiography, Hemorrhage, Stroke

Publication Date

11-15-2022

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

PubMed ID

36379702

Digital Object Identifier (DOI)

10.1136/jnis-2022-019016

Recommended Citation

Cole, Tyler S.; Rudy, Robert F.; Faridmoayer, Erfan; Gandhi, Sirin; Cavallo, Claudio; Catapano, Joshua S.; Jadhav, Ashutosh P.; Lawton, Michael T.; Albuquerque, Felipe C.; and Ducruet, Andrew F., "Relationship between cerebral vasospasm vascular territory and functional outcome after aneurysmal subarachnoid hemorrhage" (2022). Translational Neuroscience. 2282.
https://scholar.barrowneuro.org/neurobiology/2282