title: Delayed infarction following aneurysmal subarachnoid hemorrhage: Can the role of severe angiographic vasospasm really be dismissed?
abstract: BACKGROUND
  The recent literature pertaining to delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage has downplayed the role of angiographic vasospasm. However, it is our hypothesis that angiographic vasospasm has a significant pathophysiological role in this disease. We undertook an observational radiographic study of patients who presented in a delayed manner (>72 h from ictus) with evidence of severe angiographic vasospasm on initial angiography in order to describe an apparent association between vasospasm and infarct location.
  
  
  METHODS
  This was a retrospective study of consecutive patients treated at our unit. Initial, subsequent, and follow-up cross-sectional imaging with CT or MRI was analyzed in conjunction with initial angiography. Sites of angiographic narrowing, angiographic hypoperfusion, and subsequent sites of infarction were assessed.
  
  
  RESULTS
  Thirteen patients (6 women, 7 men) of mean age 49 years were assessed. Mean time to presentation was 6 days. All had severe angiographic vasospasm. Nine of the 13 patients suffered infarction; the infarcts in seven of the nine patients were large. There was correlation between sites of angiographic narrowing and infarction in all cases and eight of the nine cases showed angiographic hypoperfusion in a location corresponding to eventual infarct location.
  
  
  CONCLUSIONS
  Severe angiographic vasospasm may be linked to infarction in patients who present late. These infarcts are mostly large despite maximal treatment. We question the notion that proximal vasospasm has a minor role in delayed ischemia.
authors.affiliation: Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Mortimer
authors.affiliation: Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Brendan
authors.initials: B
authors.lastname: Steinfort
authors.affiliation: Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Faulder
authors.affiliation: Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Harrington
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Aneurysm; Angiography; Angioplasty; Stroke; Subarachnoid