title: Method of aneurysm treatment does not affect clot clearance after aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Patients undergoing neurosurgical clipping or endovascular coiling of a ruptured aneurysm may differ in their risk of vasospasm.
  
  
  OBJECTIVE
  Because clot clearance affects vasospasm, we tested the hypothesis that clot clearance differs in patients depending on method of aneurysm treatment.
  
  
  METHODS
  Exploratory analysis was performed on 413 patients from CONSCIOUS-1, a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). Clot clearance was measured by change in Hijdra score between baseline computed tomography and one performed 24 to 48 hours after aneurysm treatment. Angiographic vasospasm was assessed by the use of catheter angiography 7 to 11 days after SAH, and delayed ischemic neurological deficit (DIND) was determined clinically. Extended Glasgow Outcome Score (GOSE) was assessed 3 months after SAH, and poor outcome was defined as death, vegetative state, or severe disability. Multivariable ordinal and binary logistic regression were used.
  
  
  RESULTS
  There was no significant difference in the rate of clot clearance between patients undergoing clipping or coiling (P = .56). Coiling was independently associated with decreased severity of angiographic vasospasm (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.33-0.86), but not with DIND or GOSE. Greater clot clearance decreased the risk of severe angiographic vasospasm (OR 0.86, 95% CI 0.81-0.91), whereas higher baseline Hijdra score predicted increased angiographic vasospasm (OR 1.17, 95% CI 1.11-1.23) and poor GOSE (OR 1.09, 95% CI 1.04-1.14).
  
  
  CONCLUSIONS
  Aneurysm coiling and increased clot clearance were independently associated with decreased severity of angiographic vasospasm in multivariate analysis, although no differences in clot clearance were seen between coiled and clipped patients.
authors.affiliation: Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: George M
authors.initials: GM
authors.lastname: Ibrahim
authors.forename: Shobhan
authors.initials: S
authors.lastname: Vachhrajani
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; D000792:Angiography; D004146:Dioxanes / Q000627:therapeutic use; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D044022:Receptor, Endothelin A / Q000819:agonists; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery*; D013449:Sulfonamides / Q000627:therapeutic use; D013525:Surgical Instruments / Q000009:adverse effects*; D013777:Tetrazoles / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D004146:Dioxanes; D011725:Pyridines; D011743:Pyrimidines; D044022:Receptor, Endothelin A; D013449:Sulfonamides; D013777:Tetrazoles; C109641:clazosentan