title: Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage.
abstract: OBJECTIVE
  The long-standing concept that delayed cerebral infarction after aneurysmal subarachnoid hemorrhage results exclusively from large artery vasospasm recently has been challenged. We used data from the CONSCIOUS-1 trial to determine the relationship between angiographic vasospasm and cerebral infarction after subarachnoid hemorrhage.
  
  
  METHODS
  We performed a post hoc exploratory analysis of the CONSCIOUS-1 data. All patients underwent catheter angiography before treatment and 9±2 days after subarachnoid hemorrhage. CT was performed before and after aneurysm treatment, and 6 weeks after subarachnoid hemorrhage. Angiograms and CT scans were assessed by centralized blinded review. Angiographic vasospasm was classified as none/mild (0%-33% decrease in arterial diameter), moderate (34%-66%), or severe (≥67%). Infarctions were categorized as secondary to angiographic vasospasm, other, or unknown causes. Logistic regression was conducted to determine factors associated with infarction.
  
  
  RESULTS
  Complete data were available for 381 of 413 patients (92%). Angiographic vasospasm was none/mild in 209 (55%) patients, moderate in 118 (31%), and severe in 54 (14%). Infarcts developed in 6 (3%) of 209 with no/mild, 12 (10%) of 118 patients with moderate, and 25 (46%) of 54 patients with severe vasospasm. Multivariate analysis found a strong association between angiographic vasospasm and cerebral infarction (OR, 9.3; 95% CI, 3.7-23.4). The significant association persisted after adjusting for admission neurological grade and aneurysm size. Method of aneurysm treatment was not associated with a significant difference in frequency of infarction.
  
  
  CONCLUSIONS
  A strong association exists between angiographic vasospasm and cerebral infarction. Efforts directed at further reducing angiographic vasospasm are warranted.
authors.affiliation: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: R Webster
authors.initials: RW
authors.lastname: Crowley
authors.forename: R
authors.initials: R
authors.lastname: Medel
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Don
authors.initials: D
authors.lastname: Ilodigwe
authors.forename: Neal F
authors.initials: NF
authors.lastname: Kassell
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Daniel
authors.initials: D
authors.lastname: Ruefenacht
authors.forename: Peter
authors.initials: P
authors.lastname: Schmiedek
authors.forename: Stephan
authors.initials: S
authors.lastname: Weidauer
authors.forename: Alberto
authors.initials: A
authors.lastname: Pasqualin
authors.forename: R Loch
authors.initials: RL
authors.lastname: Macdonald
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013223:Statistics as Topic; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology