Impact of basilar artery vasospasm on outcome in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
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 (99m)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 >or=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 >or=25% experienced BS hypoperfusion, whereas only 2 of 42 patients with >or=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 >or=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.
Sviri
Gill E
GE
Department of Neurosurgery, Rambam Medical Center, Haifa, Israel. sviri@u.washington.edu
Newell
David W
DW
Lewis
David H
DH
Douville
Colleen
C
Ghodke
Basavaraj
B
Chowdhary
Minku
M
Lam
Arthur M
AM
Haynor
David
D
Zaaroor
Menashe
M
Britz
Gavin W
GW
D000328:Adult; D000368:Aged; D001488:Basilar Artery / Q000473:pathology*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy