title: Treatment modality and vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Vasospasm is the leading source of neurological morbidity after aneurysmal subarachnoid hemorrhage. Our objective was to evaluate the impact of treatment modality on vasospasm, delayed cerebral infarction, and clinical deterioration caused by delayed cerebral ischemia (CD-DCI).
  
  
  METHODS
  We reviewed an institutional cohort, comparing rates of vasospasm, delayed cerebral infarction, and CD-DCI between patients managed with only microsurgical clipping and those treated with only endovascular coiling within 72 hours of rupture. Age, sex, smoking status, Hunt-Hess grade, and Fisher grade were adjusted for in a multivariate regression model.
  
  
  RESULTS
  Two hundred three patients were treated with clipping and 52 with coiling. There was no significant difference in patient age, sex, smoking status, aneurysm location, and presenting clinical (Hunt-Hess) and radiographic (Fisher) grade between these two groups. Sixty-percent of patients had moderate or severe vasospasm after clipping compared with 38% after coiling (Multivariate odds ratio [OR] 2.32, 95% confidence interval [95% CI] 1.21-4.47, P = 0.01). Clipping was associated with a greater number of territories with vasospasm (mean of 3.1 vs. 2.3, P = 0.03 after multivariate analysis). Delayed radiographic cerebral infarction was more common in the clipping group (17% vs. 6%, multivariate OR 3.66, 95% CI 1.06-12.71, P = 0.04). For CD-DCI, a trend was seen as 16% of patients treated with clipping had CD-DCI compared with 6% of patients treated with coiling (multivariate OR 3.11, 95% CI 0.89-10.86, P = 0.07).
  
  
  CONCLUSIONS
  We demonstrate significantly lower rates of vasospasm and delayed infarction after endovascular coiling of ruptured aneurysms.
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Bradley A
authors: BA
authors: Gross
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Pui Man
authors: PM
authors: Rosalind Lai
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Kai U
authors: KU
authors: Frerichs
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: rdu@partners.org.
authors: Rose
authors: R
authors: Du
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D002548:Cerebral Revascularization / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery*; D020301:Vasospasm, Intracranial / Q000453:epidemiology / Q000209:etiology*
keywords: Aneurysm; Coiling; Ischemia; Rupture; Stroke; Subarachnoid hemorrhage; Vasospasm