Endovascular Treatment of Severe Vasospasm in Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage

Introduction: The rates of occurrence, predictors, and associated outcomes of subarachnoid hemorrhage (SAH) following endovascular treatment are not well studied. Methods: We retrospectively analyzed data from the Interventional Management of Stroke Trial (IMS III). This prospective trial randomized patients to intravenous (IV) rt-PA alone versus IV rt-PA followed by endovascular intervention. All patients underwent computed tomography (CT) at 24 hours post randomization. The scans were assessed by independent reviewers at a core laboratory for the presence, location, and type of intracranial hemorrhage.The primary outcome assessment was by modified Rankin Scale (mRS) score at 3 months. Results: Thirty four out of 434 (7.8%) patients who received endovascular treatment suffered SAH at 24 hours. There were 19 men (55.9%), and 19 patients were older than 70 years.In univariate analysis only pre-existing ischemic heart disease was identified as a predictor of SAH (p=0.03) while patient age was borderline significant (p=0.055). Three-monthmRS score was available for 24/34 patients with SAH and for 318/400 among the other patients. There was no difference in mortality (12.5% vs. 4.1%, p=0.167) or favorable outcome defined as mRS =<2 (41.7% vs. 53.5%, p=0.366). Conclusions: SAH following endovascular intervention for acute stroke is more common among patients with history of ischemic heart disease. It does not impact on functional outcome or mortality at 3 months.

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Abstract TMP105: Endovascular Treatment of Severe and Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Improves Outcome: A Systematic Review and Meta-analysis of Different Treatment Options Evaluated Since 2006 for Cerebral Vasospasm

Stroke ◽

10.1161/str.47.suppl_1.tmp105 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Gregoire Boulouis ◽

Marc-Antoine Labeyrie ◽

Jean Raymond ◽

Christine Rodriguez-Regent ◽

Anne-Claire Lukaszewicz ◽

...

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Endovascular Treatment ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Route Of Administration ◽

Unfavorable Outcome ◽

Q Value

Introduction: To report clinical outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS) targeted treatments in a systematic review and meta-analysis and compare the efficacy of endovascular and non-endovascular treatments in severe / refractory vasospasm patients. Methods: The literature was searched using PubMed, EMBASE, and The Cochrane Library database. Eligibility criteria were (1) Rated clinical outcome; (2) at least 10 patients; (3) aSAH; (4) study published in English or French (January 2006 - October 2014); and (5) methodological quality score > 10, according to STROBE criteria. Endpoint included unfavorable outcome rate, defined as mRS 3-6, GOS 1-3 or GOSE 1-4 at latest follow-up. Analyses included stratification per route of administration (oral, i.v., intra-arterial or cisternoventricular) and per study inclusion criteria (severe, CVS, refractory CVS or high risk for CVS). Univariate and multivariate subgroup analyses were performed to identify interventions associated with a better outcome. Results: Sixty-two studies, including 26 randomized controlled trials, were included (8976 patients). Overall 2490 patients had unfavorable outcome including death (random-effect weighted average: 33.7%, 99%CI, 28.1-39.7%; Q-value: 806.0, I 2 =92.7%). Clinical outcome was significantly better in severe or refractory patients for whom, on top of best medical treatment, endovascular intervention was performed (RR=0.76, IC95% [0.66-0.89], p <0.00001) whereas other route of administration didn’t show significant differences. RR of unfavorable outcome was significantly lower, vs control groups, in patients treated with Cilostazol (RR=0.46 (IC99% [0.25-0.85], P = 0.001, Q value 1.5, I 2 = 0). Conclusion: In case of CVS following aSAH, endovascular treatment in severe / refractory vasospasm patients. including intra-arterial injection of pharmacological agents or balloon angioplasty, improves outcome as compared to other route of administration.

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Ischemic Lesions in Acute and Subacute Perimesencephalic Subarachnoid Hemorrhage

American Journal of Roentgenology ◽

10.2214/ajr.18.19700 ◽

2019 ◽

Vol 212 (2) ◽

pp. 418-424 ◽

Cited By ~ 1

Author(s):

Isabel Fragata ◽

Nuno Canto-Moreira ◽

Patrícia Canhão

Keyword(s):

Subarachnoid Hemorrhage ◽

Perimesencephalic Subarachnoid Hemorrhage

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Endovascular Treatment of Bilateral Intracranial Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Hemorrhage

Operative Neurosurgery ◽

10.1227/neu.0b013e31822ed1f0 ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons75-ons81 ◽

Cited By ~ 1

Author(s):

Yong Sam Shin ◽

Byung Moon Kim ◽

Se-Hyuk Kim ◽

Sang Hyun Suh ◽

Chang Woo Ryu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Stent Insertion ◽

Treatment Methods ◽

Cerebellar Artery ◽

Endovascular Methods ◽

Dissecting Aneurysms

Abstract BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.

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Recurrent Perimesencephalic Subarachnoid Hemorrhage After 12 Years: Missed Diagnosis, Vulnerable Anatomy, or Random Events?

World Neurosurgery ◽

10.1016/j.wneu.2015.07.040 ◽

2015 ◽

Vol 84 (6) ◽

pp. 2076.e7-2076.e11 ◽

Cited By ~ 4

Author(s):

Ralph Rahme ◽

Nilesh A. Vyas

Keyword(s):

Subarachnoid Hemorrhage ◽

Perimesencephalic Subarachnoid Hemorrhage ◽

Random Events ◽

Missed Diagnosis

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Baseline characteristics and outcome for aneurysmal versus non-aneurysmal subarachnoid hemorrhage: a prospective cohort study

Neurosurgical Review ◽

10.1007/s10143-021-01650-x ◽

2021 ◽

Author(s):

Catharina Conzen ◽

Miriam Weiss ◽

Walid Albanna ◽

Katharina Seyfried ◽

Tobias P. Schmidt ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Prospective Cohort ◽

Clinical Course ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Demographic Data ◽

Delayed Cerebral Ischemia ◽

Perimesencephalic Subarachnoid Hemorrhage ◽

Glucose Levels ◽

Shunt Dependency ◽

Baseline Characteristics

AbstractThis study aims to investigate the characteristics of patients with mild aneurysmal and non-aneurysmal perimesencephalic and non-perimesencephalic subarachnoid hemorrhage (aSAH, pmSAH, npmSAH) with emphasis on admission biomarkers, clinical course, and outcome. A prospective cohort of 115 patients with aSAH (Hunt and Hess 1–3) and of 35 patients without aneurysms (16 pmSAH and 19 npmSAH) admitted between January 2014 and January 2020 was included. Demographic data, blood samples on admission, complications (hydrocephalus, shunt dependency, delayed cerebral ischemia DCI, DCI-related infarction, and mortality), and outcome after 6 months were analyzed. Demographic data was comparable between all groups except for age (aSAH 55 [48–65] vs. npmSAH 60 [56–68] vs. pmSAH 52 [42–60], p = 0.032) and loss of consciousness (33% vs. 0% vs. 0%, p = 0.0004). Admission biomarkers showed poorer renal function and highest glucose levels for npmSAH patients. Complication rate in npmSAH was high and comparable to that of aSAH patients (hydrocephalus, shunt dependency, DCI, DCI-related infarction, mortality), but nearly absent in patients with pmSAH. Favorable outcome after 6 months was seen in 92.9% of pmSAH, 83.3% of npmSAH, and 62.7% of aSAH (p = 0.0264). In this prospective cohort of SAH patients, npmSAH was associated with a complicated clinical course, comparable to that of patients with aSAH. In contrast, such complications were nearly absent in pmSAH patients, suggesting fundamental differences in the pathophysiology of patients with different types of non-aneurysmal hemorrhage. Our findings underline the importance for a precise terminology according the hemorrhage etiology as a basis for more vigilant management of npmSAH patients. NCT02142166, 05/20/2014, retrospectively registered.

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Endovascular Treatment for Recurrent Subarachnoid Hemorrhage from the Ruptured Small Aneurysm not clearly seen at the First Rupture

Japanese Journal of Neurosurgery ◽

10.7887/jcns.13.401 ◽

2004 ◽

Vol 13 (5) ◽

pp. 401-406

Author(s):

Jin MOMOJI ◽

Hiroshi SHIMABUKURO ◽

Tsutomu KADEKARU ◽

Tsuyoshi KUNIYOSHI ◽

Tsuyoshi OOKANE

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Small Aneurysm

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