Risk factors for vasospasm-induced cerebral infarct when both clipping and coiling are equally available

Abstract

Materials and Methods : In 537 patients of the Prospective Registry of Subarachnoid Aneurysms Treatment cohort, ruptured aneurysms were treated either microsurgically or endovascularly judged by the attending neurosurgeon to be appropriate for the individual patient within 3 days of onset. Factors for vasospasm-induced cerebral infarct were examined. Results : Clipping (273 patients) was preferably performed for middle cerebral artery aneurysms, while coiling (264 patients) was preferred for larger, internal carotid artery and posterior circulation aneurysms. After aneurysmal obliteration, cerebrospinal fl uid drainage was performed more in clipped patients, and antithrombotic treatment was performed more in coiled patients. Vasospasm-induced cerebral infarct occurred in 17.7 %, and multivariable logistic regression showed that vasospasm-induced cerebral infarct increased the odds of poor outcome by a factor of 5.2 (adjusted odds ratio, 5.2; 95 % confi dence interval, 2.8–9.8; P < 0.001). Multivariate analyses showed that vasospasm- induced cerebral infarct was signifi cantly associated with admission World Federation of Neurosurgical Societies grade IV–V, Fisher computed tomography (CT) group 3–4, and ruptured middle cerebral artery aneurysms. Conclusions : New treatment strategies for vasospasminduced cerebral infarct are needed, especially for ruptured middle cerebral artery aneurysm cases associated with massive SAH. Introduction : Vasospasm-induced cerebral infarct is still a signifi cant cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH).