Predictors of outcome after endovascular treatment of cerebral vasospasm.
OBJECTIVE
Angioplasty and intra-arterial papaverine are promising treatments for severe symptomatic vasospasm after subarachnoid hemorrhage (SAH), but there is little information on the clinical factors that predict treatment outcome. We sought to determine variables for predicting functional outcome in this setting.


METHODS
We reviewed 81 consecutive patients with symptomatic cerebral vasospasm from aneurysmal SAH treated with percutaneous balloon angioplasty or selective intra-arterial papaverine infusion between 1990 and 2000 (105 procedures). Logistic regression analysis was used to assess the effect of various clinical and angiographic factors on outcome.


RESULTS
Mean patient age was 54 years (range, 29-88 years). Twenty-nine patients (36%) presented with poor-grade (World Federation of Neurologic Surgeons [WFNS] grade IV or V) SAH. Clinical deficits were global in 55 patients (70%), and angiographic vasospasm was diffuse in 53 (65%). Endovascular treatment consisted of transluminal angioplasty alone (18 procedures, 17%), intra-arterial papaverine infusion (65 procedures, 62%), or both (22 procedures, 21%). Unequivocal arterial dilatation was achieved in all but two patients, and major complications occurred in 2% of the procedures. Ten patients (12%) died in the hospital, and 36 (44%) recovered poorly. Permanent deficits attributable to cerebral vasospasm were present in 37 patients (52% of survivors). On multivariate logistic regression analysis, advanced age and poor WFNS grade at presentation were predictive of poor clinical outcome.


CONCLUSIONS
Advanced age and poor clinical status at the time of SAH onset are predictive of poor clinical outcome despite endovascular treatment with angioplasty or intra-arterial papaverine in patients with symptomatic vasospasm.
Rabinstein
Alejandro A
AA
Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Friedman
Jonathan A
JA
Nichols
Douglas A
DA
Pichelmann
Mark A
MA
McClelland
Robyn L
RL
Manno
Edward M
EM
Atkinson
John L D
JL
Wijdicks
Eelco F M
EF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000800:Angioplasty, Balloon / Q000009:adverse effects; D002533:Cerebral Angiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007269:Injections, Intra-Arterial; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010208:Papaverine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy*
D014665:Vasodilator Agents; D010208:Papaverine