Acute angiographic vasospasm and the incidence of delayed cerebral vasospasm: Preliminary results

Abstract

Background: More than half of subarachnoid hemorrhage (SAH) patients develop angiographically detectable delayed cerebral vasospasm (dCVS). It mostly occurs between days 4 and 15 after ictus and can be associated with neurological defi cits that contribute to increased morbidity and mortality after SAH. Although dCVS is well studied, there are only a handful of reports on the acute phase of vasospasm (APV) occurring after treatment of intracranial aneurysms, whether ruptured or not. The aim of the current study is to elucidate the association of intraoperative cerebral vasospasm (iCVS) with the incidence of dCVS. Method: We retrospectively reviewed consecutive patients who were treated for aneurysmal SAH or incidental aneurysms during the study period. Angiograms of patients undergoing aneurysm treatment were reviewed. Spasm severity was classifi ed with respect to reduction in the transverse diameter. Mild vasospasm was defi ned as a reduction in vessel diameter of 10–30%; moderate, 30–50%; and severe vasospasm, >50%. Statistical signifi cance was tested using the X2 test with p < 0.05. Correlations between iCVS and other factors were investigated. Results: Of 109 patients, 77 patients (33 men and 44 women) presented with acute SAH and 32 patients (9 men and 23 women) were treated for incidental aneurysms. Seventeen (22%) of 77 patients presenting with acute SAH had evidence of acute (within 72 h after SAH ictus) CVS. In 16 of 17 (94.1%) patients, this vasospasm was observed immediately after treatment and was therefore termed iCVS. Eleven (30%) of 36 patients undergoing clipping and 5 (14%) of 36 patients with endovascular aneurysm occlusion had iCVS (p = 0.07). Patients presenting with acute SAH had a higher incidence of iCVS than patients undergoing elective aneurysm treatment (p = 0.02). Only one patient (3%) had iCVS in the elective treatment group whereas 16 (20%) had iCVS after SAH. The incidence of dCVS, delayed ischemic neurological defi cits (DNDs), and poor outcome in patients presenting with iCVS during surgical treatment of ruptured aneurysms was 56% (p = 0.001), 63% (p = 0.02), and 38% (p = 0.14), respectively. Conclusion: APV exists and is a common fi nding in patients with SAH. Further studies are warranted to correlate the presence of APV with postoperative ischemia, dCVS, and outcome.