title: Risk factors for vasospasm-induced cerebral infarct when both clipping and coiling are equally available.
abstract: BACKGROUND
  Vasospasm-induced cerebral infarct is still a significant cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH).
  
  
  METHODS
  In 537 patients of the Prospective Registry of Subarachnoid Aneurysms Treatment cohort, ruptured aneurysms were treated either microsurgically or endovascularly judged by the attending neurosurgeon to be appropriate for the individual patient within 3 days of onset. Factors for vasospasm-induced cerebral infarct were examined.
  
  
  RESULTS
  Clipping (273 patients) was preferably performed for middle cerebral artery aneurysms, while coiling (264 patients) was preferred for larger, internal carotid artery and posterior circulation aneurysms. After aneurysmal obliteration, cerebrospinal fluid drainage was performed more in clipped patients, and antithrombotic treatment was performed more in coiled patients. Vasospasm-induced cerebral infarct occurred in 17.7 %, and multivariable logistic regression showed that vasospasm-induced cerebral infarct increased the odds of poor outcome by a factor of 5.2 (adjusted odds ratio, 5.2; 95 % confidence interval, 2.8-9.8; P < 0.001). Multivariate analyses showed that vasospasm-induced cerebral infarct was significantly associated with admission World Federation of Neurosurgical Societies grade IV-V, Fisher computed tomography (CT) group 3-4, and ruptured middle cerebral artery aneurysms.
  
  
  CONCLUSIONS
  New treatment strategies for vasospasm-induced cerebral infarct are needed, especially for ruptured middle cerebral artery aneurysm cases associated with massive SAH.
authors.affiliation: Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kanamaru
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
authors.forename: Waro
authors.initials: W
authors.lastname: Taki
mesh_terms: D000328:Adult; D020771:Anterior Cerebral Artery; D002343:Carotid Artery, Internal; D002544:Cerebral Infarction / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D020768:Middle Cerebral Artery; D016017:Odds Ratio; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000453:epidemiology / Q000601:surgery / Q000628:therapy