Functional outcomes following endovascular treatment of vasospasm secondary to aneurysmal subarachnoid Hemorrhage: A Single center retrospective analysis

Abstract

Introduction

Endovascular treatment of post-hemorrhagic cerebral vasospasm (PHCV) has the potential to improve functional outcomes but there continues to be limited data reported in the literature.

Objective

To retrospectively review our institution’s experience treating PHCV endovascularly and report clinical outcome data.

Methods

Patients who experienced nontraumatic subarachnoid hemorrhage (SAH) and were treated with endovascular therapy were identified using ICD and CPT codes. Demographic, clinical, and outcome variables were then collected via review of electronic medical records. The primary outcome measure was rate of modified Rankin Score (mRS) ≤ 2 at discharge as well as 1, 3, and 6 months after discharge. Discharge disposition, angiographic response to treatment, and complication rates were secondary outcomes. A subgroup analysis was performed on patients treated with retrievable stents.

Results

In a 12.5 year period, 1396 patients with nontraumatic SAH were treated, and of these 82/1396 (5.9 %) were treated endovascularly for vasospasm. 200 total interventions were performed on 82 patients. 29.7 % of patients had radiographic delayed cerebral ischemia. The complication rates were 3.5 % per procedure and 4.9 % per patient. 40.7 % of patients had good neurologic outcomes (mRS ≤ 2) at any time point. In-hospital mortality was 11 % and 6-month mortality was 21 %. Higher presenting Glasgow Coma Score (GCS) predicted good neurologic outcome in univariable logistic regression (OR = 1.33, p = 0.026). Patients that underwent mechanical angioplasty were significantly younger than those who did not (46 years vs 53 years, p = 0.003). 11 cases of retrievable stent angioplasty were performed, yielding a complication rate of 9 % which was comparable to the complication rate of patients treated with balloon angioplasty (4.3 %, p = 0.54).

Conclusions

Our experience with endovascular treatment of PHCV results in similar functional outcomes and complication rates to the literature. Better presenting GCS predicts good functional outcomes in patients with PHCV treated endovascularly. Patients undergoing mechanical angioplasty tended to be younger. Retrievable stents produced similar rates of complications and good functional outcomes to balloon angioplasty patients.