title: Early Vasospasm after Aneurysmal Subarachnoid Hemorrhage Predicts the Occurrence and Severity of Symptomatic Vasospasm and Delayed Cerebral Ischemia.
abstract: Cerebral vasospasm usually develops several days after subarachnoid hemorrhage (SAH) and is generally acknowledged as a strong outcome predictor. In contrast, much less is known about the nature and eventual consequences of early angiographic vasospasm (EAVS) seen on admission digital subtraction angiography (DSA). Therefore, we aimed at identifying the risk factors and clinical impact of EAVS after SAH.
  
  
  
  Five hundred and thirty-one SAH patients with admission DSA performed within 72 h after the bleeding event were selected from a comprehensive database containing all consecutive SAH patients treated at our institution between January 2005 and December 2012. Predictors of EAVS, as well as associations between EAVS and delayed vasospasm-related complications, and unfavorable outcome (defined as modified Rankin scale >3) were evaluated in univariate and multivariate analyses.
  
  
  
  EAVS was seen on 60 DSAs (11.3%) and was independently correlated with delayed symptomatic vasospasm requiring intra-arterial spasmolysis (OR 5.24, p < 0.0001), angioplasty (OR 2.56, p = 0.015) and repetitive endovascular treatment (OR 4.71, p < 0.0001). EAVS also increased the risk for multiple versus single territorial infarction on the follow-up CT scan(s) (OR 2.04, p = 0.047) and independently predicted unfavorable outcome (OR 2.93, p = 0.008). The presence of radiographic signs suspicious for fibromuscular dysplasia were independently associated with the occurrence of EAVS (OR 2.98, p = 0.026) and the need for repetitive endovascular vasospasm treatment (OR 3.95, p = 0.019).
  
  
  
  In view of the strong correlation with delayed symptomatic vasospasm and its ischemic complications, EAVS can be considered an alerting signal for severe symptomatic vasospasm. Therefore, more attention should be paid to the presence of EAVS on admission DSA.
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Jabbarli
authors.forename: Matthias
authors.initials: M
authors.lastname: Reinhard
authors.forename: Mukesch
authors.initials: M
authors.lastname: Shah
authors.forename: Roland
authors.initials: R
authors.lastname: Roelz
authors.forename: Wolf-Dirk
authors.initials: WD
authors.lastname: Niesen
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaier
authors.forename: Christian
authors.initials: C
authors.lastname: Taschner
authors.forename: Astrid
authors.initials: A
authors.lastname: Weyerbrock
authors.forename: Vera
authors.initials: V
authors.lastname: Van Velthoven
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D055815:Young Adult