title: Impact of basilar artery vasospasm on outcome in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Rambam Medical Center, Haifa, Israel. sviri@u.washington.edu
authors.forename: Gill E
authors.initials: GE
authors.lastname: Sviri
authors.forename: David W
authors.initials: DW
authors.lastname: Newell
authors.forename: David H
authors.initials: DH
authors.lastname: Lewis
authors.forename: Colleen
authors.initials: C
authors.lastname: Douville
authors.forename: Basavaraj
authors.initials: B
authors.lastname: Ghodke
authors.forename: Minku
authors.initials: M
authors.lastname: Chowdhary
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Lam
authors.forename: David
authors.initials: D
authors.lastname: Haynor
authors.forename: Menashe
authors.initials: M
authors.lastname: Zaaroor
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
mesh_terms: 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