302 Validation of the Barrow Neurological Institute Scale for Symptomatic Vasospasm Prediction Following Aneurysmal Subarachnoid Hemorrhage

Abstract INTRODUCTION The Barrow Neurological Institute (BNI) scale was introduced in 2012 as a simple and quantitative method for symptomatic vasospasm prediction following aneurysmal subarachnoid hemorrhage (SAH). The scale was developed from data collected from 218 patients from the Barrow Ruptured Aneurysm Trial (BRAT). Validation of this scale in a large, multicenter aneurysmal SAH cohort may encourage its use in broader clinical neurovascular practice. METHODS The records of 474 patients with aneurysmal SAH were studied to evaluate the predictive capacities of the BNI and original Fisher scales. The study sample included 241 patients from Massachusetts General Hospital (MGH) and 233 patients from the University of California, San Francisco (UCSF). RESULTS >Within this external cohort, the mean age at the time of presentation was 55.7 years and there were 353 (74.5%) female patients. Of the 474 total patients, 108 (22.8%) developed symptomatic vasospasm, which occurred in 44% and 42.4% of patients with BNI grade 4 and 5 SAH, respectively, and 26.7% of patients with Fisher grade 3 SAH. Chi-square for trend analysis demonstrated that the BNI scale (Chi-square 40.9, P < 0.0001) performed better than the Fisher scale (Chi-square 7.9, P = 0.0048) with respect to symptomatic vasospasm prediction in the combined cohort. Mean intra- and inter-observer agreement was greater for the BNI scale (kappa 0.83 and kappa 0.76, respectively) than the Fisher scale (kappa 0.62 and kappa 0.52, respectively). CONCLUSION The present study demonstrates that the BNI scale reliably predicts symptomatic vasospasm in a large, multicenter cohort of 474 patients. The quantitative nature of the BNI scale circumvents the potential subjectivity associated with Fisher scale assessments, which may result in more reliable SAH measurements and predictions regarding symptomatic vasospasm development.

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Leukocytosis as an independent risk factor for cerebral vasospasm following aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2003.98.6.1222 ◽

2003 ◽

Vol 98 (6) ◽

pp. 1222-1226 ◽

Cited By ~ 89

Author(s):

Matthew J. McGirt ◽

John C. Mavropoulos ◽

Laura Y. McGirt ◽

Michael J. Alexander ◽

Allan H. Friedman ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Leukocyte Count ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Content Type ◽

Symptomatic Vasospasm ◽

Fisher Grade ◽

Increased Risk ◽

Grade 3 ◽

Fine Print

Object. The identification of patients at an increased risk for cerebral vasospasm after subarachnoid hemorrhage (SAH) may allow for more aggressive treatment and improved patient outcomes. Note, however, that blood clot size on admission remains the only factor consistently demonstrated to increase the risk of cerebral vasospasm after SAH. The goal of this study was to assess whether clinical, radiographic, or serological variables could be used to identify patients at an increased risk for cerebral vasospasm. Methods. A retrospective review was conducted in all patients with aneurysmal or spontaneous nonaneurysmal SAH who were admitted to the authors' institution between 1995 and 2001. Underlying vascular diseases (hypertension or chronic diabetes mellitus), Hunt and Hess and Fisher grades, patient age, aneurysm location, craniotomy compared with endovascular aneurysm stabilization, medications on admission, postoperative steroid agent use, and the occurrence of fever, hydrocephalus, or leukocytosis were assessed as predictors of vasospasm. Two hundred twenty-four patients were treated for SAH during the review period. One hundred one patients (45%) developed symptomatic vasospasm. Peak vasospasm occurred 5.8 ± 3 days after SAH. There were four independent predictors of vasospasm: Fisher Grade 3 SAH (odds ratio [OR] 7.5, 95% confidence interval [CI] 3.5–15.8), peak serum leukocyte count (OR 1.09, 95% CI 1.02–1.16), rupture of a posterior cerebral artery (PCA) aneurysm (OR 0.05, 95% CI 0.01–0.41), and spontaneous nonaneurysmal SAH (OR 0.14, 95% CI 0.04–0.45). A serum leukocyte count greater than 15 × 109/L was independently associated with a 3.3-fold increase in the likelihood of developing vasospasm (OR 3.33, 95% CI 1.74–6.38). Conclusions. During this 7-year period, spontaneous nonaneurysmal SAH and ruptured PCA aneurysms decreased the odds of developing vasospasm sevenfold and 20-fold, respectively. The presence of Fisher Grade 3 SAH on admission or a peak leukocyte count greater than 15 × 109/L increased the odds of vasospasm sevenfold and threefold, respectively. Monitoring of the serum leukocyte count may allow for early diagnosis and treatment of vasospasm.

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Effect of Clipping, Craniotomy, or Intravascular Coiling on Cerebral Vasospasm and Patient Outcome after Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/01.neu.0000137628.51839.d5 ◽

2004 ◽

Vol 55 (4) ◽

pp. 779-789 ◽

Cited By ~ 84

Author(s):

Brian L. Hoh ◽

Mehmet A. Topcuoglu ◽

Aneesh B. Singhal ◽

Johnny C. Pryor ◽

James D. Rabinov ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Mortality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Poor Grade ◽

Poor Outcome ◽

Symptomatic Vasospasm ◽

Fisher Grade ◽

Significant Difference ◽

Good Grade ◽

Grade 3

Abstract OBJECTIVE: Although several recent studies have suggested that the incidence of vasospasm after aneurysmal subarachnoid hemorrhage is lower in patients undergoing aneurysmal coiling as compared with clipping, other studies have had conflicting results. We reviewed our experience over 8 years and assessed whether clipping, craniotomy, or coiling affects patient outcomes or the risk for vasospasm. METHODS: We included 515 patients with aneurysmal subarachnoid hemorrhage, identified prospectively from November 2000 to February 2003 (243 patients) and retrospectively from November 1995 to October 2000 (272 patients), by using International Classification of Diseases, 9th Revision, codes for subarachnoid hemorrhage. We classified patients as follows: clipping (413 patients), coiling (79 patients), and craniotomy (436 patients, including all 413 patients who underwent clipping plus 23 who underwent coiling as well as craniotomy for various reasons). We studied four outcome measures: total vasospasm, symptomatic vasospasm, poor outcome (modified Rankin score 3–6), and in-hospital mortality. To assess the risk of total vasospasm and symptomatic vasospasm, we performed multivariate regression analyses adjusting for age, Fisher grade, Hunt and Hess grade, aneurysm location (anterior versus posterior circulation), and aneurysm treatment modality. To assess the risk for poor outcome and in-hospital mortality, we adjusted for all the above variables as well as for total and symptomatic vasospasm. RESULTS: In the clipping group there was 63% total vasospasm and 28% symptomatic vasospasm; in the coiling group there was 54% total vasospasm and 33% symptomatic vasospasm; and in the craniotomy group there was 64% total vasospasm and 28% symptomatic vasospasm. In the multivariate analysis, age <50 years (P = 0.0099) and Fisher Grade 3 (P < 0.00001) predicted total vasospasm, and Fisher Grade 3 (P < 0.000001) and Hunt and Hess Grade IV or V (P = 0.018) predicted symptomatic vasospasm. Predictors of poor outcome were age ≥50 years (P < 0.0001), Fisher Grade 3 (P = 0.0072), Hunt and Hess Grade IV or V (P < 0.00001), symptomatic vasospasm (P < 0.0001), and coiling (P = 0.0314 versus clipping and P = 0.045 versus craniotomy). Predictors of in-hospital mortality were age ≥ 50 years (P = 0.0030), Hunt and Hess Grade IV or V (P = 0.0001), symptomatic vasospasm (P < 0.00001), and coiling (P = 0.008 versus clipping and P = 0.0013 versus craniotomy). There was no significant difference in total vasospasm or symptomatic vasospasm when patients who underwent clipping or craniotomy were compared with patients who underwent coiling. In patients with Hunt and Hess Grade I to III (“good grade”), clipping and craniotomy were associated with better outcome and less in-hospital mortality, but there was no difference in total vasospasm or symptomatic vasospasm versus coiling. In patients with Hunt and Hess Grade IV or V (“poor grade”), there was no difference in any outcome measure among the treatment groups. CONCLUSION: In a single-center, retrospective, nonrandomized study, performance of clipping and/or craniotomy had significantly better outcome and lower mortality at discharge than coiling in good-grade patients but had no effect on total vasospasm or symptomatic vasospasm in good- or poor-grade patients.

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Cigarette smoking—induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1997.87.3.0381 ◽

1997 ◽

Vol 87 (3) ◽

pp. 381-384 ◽

Cited By ~ 83

Author(s):

Todd M. Lasner ◽

Robert J. Weil ◽

Howard A. Riina ◽

Joseph T. King ◽

Eric L. Zager ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Alcohol Abuse ◽

Cigarette Smoking ◽

Cerebral Vasospasm ◽

Odds Ratio ◽

Aneurysmal Subarachnoid Hemorrhage ◽

World Federation ◽

Symptomatic Vasospasm ◽

Fisher Grade ◽

Grade 3

✓ Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is correlated with the thickness of blood within the basal cisterns on the initial computerized tomography (CT) scan. To identify additional risk factors for symptomatic vasospasm, the authors performed a prospective analysis of 75 consecutively admitted patients who were treated for aneurysmal SAH. Five patients who died before treatment or were comatose postoperatively were excluded from the study. Of the remaining 70 patients, demographic (age, gender, and race) and clinical (hypertension, diabetes, coronary artery disease, smoking, alcohol abuse, illicit drug use, sentinel headache, Fisher grade, Hunt and Hess grade, World Federation of Neurological Surgeons grade, and ruptured aneurysm location) parameters were evaluated using multivariate logistic regression to determine factors independently associated with cerebral vasospasm. All patients were treated with hypervolemic therapy and administration of nimodipine as prophylaxis for vasospasm. Cerebral vasospasm was suspected in cases that exhibited (by elevation of transcranial Doppler velocities) neurological deterioration 3 to 14 days after SAH with no other explanation and was confirmed either by clinical improvement in response to induced hypertension or by cerebral angiography. The mean age of the patients was 50 years. Sixty-three percent of the patients were women, 74% were white, 64% were cigarette smokers, and 46% were hypertensive. Ten percent of the patients suffered from alcohol abuse, 19% from sentinel bleed, and 49% had a Fisher Grade 3 SAH. Twenty-nine percent of the patients developed symptomatic vasospasm. Multivariate analysis demonstrated that cigarette smoking (p = 0.033; odds ratio 4.7, 95% confidence interval [CI] 2.4–8.9) and Fisher Grade 3, that is, thick subarachnoid clot (p = 0.008; odds ratio 5.1, 95% CI 2–13.1), were independent predictors of symptomatic vasospasm. The authors make the novel observation that cigarette smoking increases the risk of symptomatic vasospasm after aneurysmal SAH, independent of Fisher grade.

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167 High Throughput Metabolite Profiling Identifies Plasma Anandamide as a Biomarker of Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽

10.1093/neuros/nyx417.167 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 242-243

Author(s):

Christopher J Stapleton ◽

Hannah Irvine ◽

Zoe Wolcott ◽

Aman B Patel ◽

Jonathan Rosand ◽

...

Keyword(s):

Logistic Regression ◽

Subarachnoid Hemorrhage ◽

Functional Outcome ◽

High Throughput ◽

Metabolite Profiling ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Plasma Samples ◽

Symptomatic Vasospasm ◽

Good Functional Outcome ◽

Fisher Grade

Abstract INTRODUCTION The quantification of metabolites in plasma samples in patients with aneurysmal subarachnoid hemorrhage (aSAH) can highlight important alterations in critical metabolic pathways. As metabolites reflect changes associated with disease conditions, metabolite profiling (metabolomics) can identify candidate biomarkers for disease and potentially uncover pathways for intervention. METHODS We performed high throughput metabolite profiling across a broad spectrum of chemical classes (173 metabolites) on plasma samples taken from 119 patients with aSAH. Samples were drawn at 3 time points following ictus: 2–4, 7–10, and 12–14 days. Univariate and logistic regression analyses were performed to examine the relation of each metabolite with multiple outcome variables, including short- and long-term functional outcome (modified Rankin Scale, mRS). RESULTS >A good functional outcome (mRS 0–2) was found in 63.1% and 66.7% of patients at 30 and 90 days, respectively, following aSAH. Plasma concentrations of the endogenous cannabinoid anandamide during days 2–4 after aneurysmal SAH were decreased by 48.1% (P < 0.0001) and 57.6% (P <0.0001) in patients with mRS 0–2 at 30 and 90 days, respectively. A similar statistical result was noted with plasma anandamide concentrations averaged across all time periods. Logistic regression further demonstrated that anandamide remained an independent predictor of functional outcome (30 days: P = 0.04; 90 days: P = 0.03), even after adjusting for other factors that influence outcome, including age, World Federation of Neurological Surgeons grade (WFNS), Fisher grade, and symptomatic vasospasm. CONCLUSION Decreased plasma anandamide following aSAH predicts a good functional outcome at 30 and 90 days. While a role for anandamide in aneurysmal SAH has not been previously reported, elevated anandamide levels have been implicated in neuronal apoptosis and cerebral edema in the acutely injured brain. These data highlight the increasing capability of metabolomics techniques in profiling large-sized cohorts to illuminate novel markers of disease and potential metabolic regulators.

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Evaluation Of Intra-Arterial Nimodipine Therapy In Post-Subarachnoid Hemorrhage Refractory Cerebral Vasospasm

10.21203/rs.3.rs-482464/v1 ◽

2021 ◽

Author(s):

Shrey Jain ◽

Ajit Kumar Sinha ◽

Sumit Goyal

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Neurological Assessment ◽

Minimum Risk ◽

Operative Morbidity ◽

Fisher Grade ◽

Grade 3 ◽

Triple H

Abstract Background: Cerebral vasospasm is a major cause of morbidity and mortality in patients with subarachnoid hemorrhage. Vasospasm is managed with triple H and vasodilators but sometimes, patients do not respond. Intra-arterial vasodilator infusion has been shown to improve outcome in such patients. In this study, we try to evaluate the efficacy of intra-arterial nimodipine therapy in 43 patients of post-aneurysmal subarachnoid hemorrhage refractory cerebral vasospasm. Methods: It is a prospective observational study of a group of 43 patients presenting with refractory cerebral vasospasm as per the inclusion criteria. Pre-procedure neurological assessment and Transcranial Doppler (TCD) monitoring were done. Endovascular spasmolysis was conducted and post-operative morbidity and outcomes were noted. Follow up of the patients was done at the time of discharge and at 6 months according to the Modified Rankin Scale and NCCT head. Results: Most of the patients developing refractory cerebral vasospasm belonged to Hunt and Hess Grade 2 and 3 and Fisher grade 3 and 4. 87.5% of the patients showed clinical recovery following endovascular spasmolysis and 58% of the patients showed complete angiographic recovery. Outcome after 6 months was good in 76%, moderate in 12% and poor in 12% patients. NCCT head showed no infarct in 58%, minor infarct in 28% and major vascular territorial infarct in 14% patients. Conclusions: Intra-arterial nimodipine infusion is a safe and effective therapy with minimum risk of complications if adhered to standard endovascular practice. By timely intervention, major ischemic insult to the brain can be averted, thereby significantly improving the prognosis.

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Safety and efficacy of transluminal balloon angioplasty in the prevention of vasospasm in patients with Fisher Grade 3 subarachnoid hemorrhage: a pilot study

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.4.8 ◽

1998 ◽

Vol 5 (4) ◽

pp. E7 ◽

Cited By ~ 5

Author(s):

J. Paul Muizelaar ◽

Marike Zwienenberg ◽

Nancy A. Mini ◽

Stephen T. Hecht

Keyword(s):

Subarachnoid Hemorrhage ◽

Pilot Study ◽

Balloon Angioplasty ◽

Time Window ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Randomized Study ◽

Pilot Trial ◽

Safety And Efficacy ◽

Fisher Grade ◽

Grade 3

Recent advances in neuroradiology have made it possible to dilate human cerebral arteries that show vasospasm following aneurysmal subarachnoid hemorrhage (SAH), but the time window is short and the success rate for reversal of delayed ischemic neurological deficit (DIND) varies between 31% and 77%. In a canine model of vasospasm, transluminal balloon angioplasty (TBA) performed on Day 0 (the day of aneurysm rupture) has been shown to completely prevent the development of angiographically demonstrated narrowing by Day 7; this effect is better than any pharmacological treatment for vasospasm thus far described. The authors conducted a pilot trial to assess the safety and efficacy of TBA performed within 3 days post-SAH. Twelve patients with a very high probability of developing vasospasm (Fisher Grade 3) were included. Target vessels for prophylactic TBA were the internal carotid artery, A1 segment, M1 segment, and P1 segment bilaterally, the basilar artery, and the vertebral artery. No patient developed DIND or more than mild vasospasm, according to transcranial Doppler criteria. At 3 months, seven patients made a good recovery, two patients were moderately disabled, and three patients died; one patient died because of a vessel rupture during TBA and two older patients died of medical complications associated with an already poor clinical condition at admission. Compared with the results of large series reported in literature of patients with aneurysmal SAH, the results of this pilot study indicate an extremely low incidence of vasospasm and DIND after patients underwent prophylactic TBA. A larger, randomized study, however, is required to determine whether prophylactic TBA is efficacious enough to justify the risks.

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Magnesium infusion for vasospasm prophylaxis after subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2006.105.5.723 ◽

2006 ◽

Vol 105 (5) ◽

pp. 723-729 ◽

Cited By ~ 46

Author(s):

Martina Stippler ◽

Elizabeth Crago ◽

Elad I. Levy ◽

Mary E. Kerr ◽

Howard Yonas ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Doppler Ultrasonography ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Treated Group ◽

Aneurysm Rupture ◽

Current Standard ◽

Ruptured Aneurysms ◽

Symptomatic Vasospasm ◽

Fisher Grade ◽

Significant Difference

Object Despite the application of current standard therapies, vasospasm continues to result in death or major disability in patients treated for ruptured aneurysms. The authors investigated the effectiveness of continous MgSO4 infusion for vasospasm prophylaxis. Methods Seventy-six adults (mean age 54.6 years; 71% women; 92% Caucasian) were included in this comparative matched-cohort study of patients with aneurysmal subarachnoid hemorrhage on the basis of computed tomography (CT) findings. Thirty-eight patients who received continuous MgSO4 infusion were matched for age, race, sex, treatment option, Fisher grade, and Hunt and Hess grade to 38 historical control individuals who did not receive MgSO4 infusion. Twelve grams of MgSO4 in 500 ml normal saline was given intravenously daily for 12 days if the patient presented within 48 hours of aneurysm rupture. Vasospasm was diagnosed on the basis of digital substraction angiography, CT angiography, and transcranial Doppler ultrasonography, and evidence of neurological deterioration. Symptomatic vasospasm was present at a significantly lower frequency in patients who received MgSO4 infusion (18%) compared with patients who did not receive MgSO4 (42%) (p = 0.025). There was no significant difference in mortality rate at discharge (p = 0.328). A trend toward improved outcome as measured by the modifed Rankin Scale (p = 0.084), but not the Glasgow Outcome Scale (p = 1.0), was seen in the MgSO4-treated group. Conclusions Analysis of the results suggests that MgSO4 infusion may have a role in cerebral vasospasm prophylaxis if therapy is initiated within 48 hours of aneurysm rupture.

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Preventive effects of cilostazol against the development of shunt-dependent hydrocephalus after subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2016.5.jns152907 ◽

2017 ◽

Vol 127 (2) ◽

pp. 319-326 ◽

Cited By ~ 14

Author(s):

Yoshinari Nakatsuka ◽

Fumihiro Kawakita ◽

Ryuta Yasuda ◽

Yasuyuki Umeda ◽

Naoki Toma ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Multivariate Analyses ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Matricellular Protein ◽

Chronic Hydrocephalus ◽

Multivariate Logistic Regression ◽

Fisher Grade ◽

Grade 3 ◽

Phosphodiesterase Type ◽

Preventive Effects

OBJECTIVEChronic hydrocephalus develops in association with the induction of tenascin-C (TNC), a matricellular protein, after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to examine if cilostazol, a selective inhibitor of phosphodiesterase Type III, suppresses the development of chronic hydrocephalus by inhibiting TNC induction in aneurysmal SAH patients.METHODSThe authors retrospectively reviewed the factors influencing the development of chronic shunt-dependent hydrocephalus in 87 patients with Fisher Grade 3 SAH using multivariate logistic regression analyses. Cilostazol (50 or 100 mg administered 2 or 3 times per day) was administered from the day following aneurysmal obliteration according to the preference of the attending neurosurgeon. As a separate study, the effects of different dosages of cilostazol on the serum TNC levels were chronologically examined from Days 1 to 12 in 38 SAH patients with Fisher Grade 3 SAH.RESULTSChronic hydrocephalus occurred in 12 of 36 (33.3%), 5 of 39 (12.8%), and 1 of 12 (8.3%) patients in the 0 mg/day, 100 to 200 mg/day, and 300 mg/day cilostazol groups, respectively. The multivariate analyses showed that older age (OR 1.10, 95% CI 1.13–1.24; p = 0.012), acute hydrocephalus (OR 23.28, 95% CI 1.75–729.83; p = 0.016), and cilostazol (OR 0.23, 95% CI 0.05–0.93; p = 0.038) independently affected the development of chronic hydrocephalus. Higher dosages of cilostazol more effectively suppressed the serum TNC levels through Days 1 to 12 post-SAH.CONCLUSIONSCilostazol may prevent the development of chronic hydrocephalus and reduce shunt surgery, possibly by the inhibition of TNC induction after SAH.

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Stereotactic Catheter Ventriculocisternostomy for Clearance of Subarachnoid Hemorrhage in Patients with Coiled Aneurysms

Operative Neurosurgery ◽

10.1093/ons/opx129 ◽

2017 ◽

Vol 14 (3) ◽

pp. 231-235 ◽

Cited By ~ 5

Author(s):

Roland Roelz ◽

Christian Scheiwe ◽

Horst Urbach ◽

Volker A Coenen ◽

Peter Reinacher

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Blood Clearance ◽

Fisher Grade ◽

Rapid Clearance ◽

Promising Treatment ◽

Grade 3 ◽

Subarachnoid Blood ◽

The Brain

Abstract BACKGROUND Cerebral vasospasm leading to delayed cerebral infarction (DCI) is a central source of poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Current treatments of cerebral vasospasm are insufficient. Cisternal blood clearance is a promising treatment option. However, a generally applicable, safe, and effective method to access the cisterns of the brain is lacking. OBJECTIVE To report on stereotactic catheter ventriculocisternostomy (STX-VCS) as a method to access the cisterns of the brain for clearance of subarachnoid hemorrhage in patients with aSAH and coiled aneurysms. METHODS In 9 aSAH patients at high risk for DCI (Hunt and Hess grade ≥3, modified Fisher grade ≥3), access to the basal cisterns of the brain was created by STX-VCS. Fibrinolytic and/or spasmolytic lavage therapy was administered. RESULTS STX-VCS was feasible and safe in all patients. Subarachnoid blood was rapidly cleared by irrigation with urokinase. Vasospasm occurred in 2 patients and was interrupted by irrigation with nimodipine. There was 1 fatality due to pneumogenic sepsis. Minor DCI occurred in 1 patient. Eight survived without DCI and are independent (modified Rankin score [mRS] ≤ 3) at 6 mo after aSAH. CONCLUSION STX-VCS allows for rapid clearance of subarachnoid hemorrhage in patients with coiled aneurysms.

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Increased blood pressure variability predicts poor outcomes from endovascular treatment for aneurysmal subarachnoid hemorrhage

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0167 ◽

2021 ◽

Vol 79 (9) ◽

pp. 759-765

Author(s):

Xin-Bo Ge ◽

Qun-Fu Yang ◽

Zhen-Bo Liu ◽

Tao Zhang ◽

Chao Liang

Keyword(s):

Blood Pressure ◽

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Blood Pressure Variability ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Significant Risk ◽

Endovascular Embolization ◽

Fisher Grade ◽

Grade 3 ◽

Poor Outcomes

ABSTRACT Background: Predictors of outcomes following endovascular treatment (ET) for aneurysmal subarachnoid hemorrhage (aSAH) are not well-defined. Identifying them would be beneficial in determining which patients might benefit from ET. Objective: To identify the predictive factors for poor outcomes following ET for aSAH. Methods: 120 patients with ruptured cerebral aneurysms underwent endovascular embolization between January 2017 and December 2018. Blood pressure variability was examined using the standard deviation of the 24-hour systolic blood pressure (24hSSD) and 24-hour diastolic blood pressure (24hDSD). Predictors were identified through univariate and multivariate regression analysis. All patients were followed up for three months. Results: At follow-up, 86 patients (71.7%) had good outcomes and 34 (28.3%) had poor outcomes. Patients with poor outcomes had significantly higher 24hSSD than those with good outcomes (19.3 ± 5.5 vs 14.1 ± 4.8 mmHg; P < 0.001). The 24hDSD did not differ significantly between patients with good outcomes and those with poor outcomes (9.5 ± 2.3 vs 9.9 ± 3.5 mmHg; P = 0.464). The following were significant risk factors for poor outcomes after endovascular embolization: age ≥ 65 years (odds ratio [OR] = 23.0; 95% confidence interval [CI]: 3.0-175.9; P = 0.002); Hunt-Hess grade 3-4 (OR = 6.8; 95% CI: 1.1-33.7; P = 0.039); Fisher grade 3-4 (OR = 47.1; 95% CI: 3.8-586.5; P = 0.003); postoperative complications (OR = 6.1; 95% CI: 1.1-34.8; P = 0.042); and 24hSSD ≥ 15 mmHg (OR = 14.9; 95% CI: 4.0-55.2; P < 0.001). Conclusion: Elevated 24hSSD is a possibly treatable predictive factor for poor outcomes after ET for aSAH.

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