Impact of basilar artery vasospasm on outcome in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Gill E. Sviri, David W. Newell, David H. Lewis, Colleen Douville, Basavaraj Ghodke, Minku Chowdhary, Arthur M. Lam, David Haynor, Menashe Zaaroor, Gavin W. Britz

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

BACKGROUND AND PURPOSE - The purpose of the present study was to evaluate the impact of basilar artery (BA) vasospasm on outcome in patients with severe vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). METHODS - Sixty-five patients with clinically suspect severe cerebral vasospasm after aSAH underwent cerebral angiography before endovascular treatment. Vasospasm severity was assessed for each patient by transcranial Doppler measurements, angiography, and Tc-ethylcysteinate dimer single-photon emission computed tomography (ECD-SPECT) imaging. Percentage of BA narrowing was calculated in reference to the baseline angiogram. RESULTS - BA narrowing ≥25% was found in 23 of 65 patients, and delayed brain stem (BS) hypoperfusion, as estimated by ECD-SPECT, was found in 16. Fourteen of 23 patients with BA narrowing ≥25% experienced BS hypoperfusion, whereas only 2 of 42 patients with ≥25% BA narrowing experienced BS ischemia (P<0.001). Stepwise logistic regression after adjusting for age with Hunt and Hess grade, Fisher grade, hydrocephalus, and aneurysmal location as covariables revealed BA narrowing ≥25% and delayed BS hypoperfusion to be significantly and independently associated with unfavorable 3-month outcome (P=0.0001; odds ratio, 10.1; 95% CI, 2.5 to 40.8; and P=0.007; odds ratio, 13.8, 95% CI, 2.18 to 91.9, respectively). CONCLUSIONS - These findings suggest for the first time that BA vasospasm after aSAH is an independent and significant prognostic factor associated with poor outcome in patients with severe cerebral vasospasm requiring endovascular therapy. Further study should be done to evaluate the role of interventional therapy on outcome in patients with posterior circulation vasospasm.

Original languageEnglish (US)
Pages (from-to)2738-2743
Number of pages6
JournalStroke
Volume37
Issue number11
DOIs
StatePublished - Nov 2006

Keywords

  • Angiography
  • Basilar artery
  • Cerebral blood flow
  • Single-photon emission computed tomography
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

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