title: Safety and outcomes of simultaneous vasospasm and endovascular aneurysm treatment (SVAT) in subarachnoid hemorrhage.
abstract: BACKGROUND
  Simultaneous vasospasm and endovascular aneurysm treatment (SVAT) has been shown to be effective with good clinical outcomes in small series, but these studies have not examined predictive factors for clinical outcome after treatment.
  
  
  OBJECTIVE
  To identify the safety and efficacy of SVAT in a large multicenter patient cohort and evaluate prognostic markers of clinical outcome following SVAT.
  
  
  METHODS
  This study retrospectively enrolled 50 consecutive patients undergoing SVAT at 11 different centers. We analyzed Hunt and Hess and Fisher grades, aneurysm location, angiographic vasospasm grade, Glasgow Outcome Scale (GOS) at discharge, and 90-day modified Rankin Scale (mRS) scores.
  
  
  RESULTS
  A total of 50 patients undergoing SVAT between the years 2003 and 2009 were identified. Patients presented, on average, 6.48±4.45 days after subarachnoid hemorrhage. Hunt and Hess and Fisher grades were 1 (n=7), 2 (n=12), 3 (n=14), 4 (n=15), 5 (n=2), and 3 and 4 (n=33), respectively. Aneurysm location was distributed as follows: anterior (n=32), posterior (n=16), anterior and posterior (n=2). Patients with good clinical condition (Hunt and Hess score 1-3) had significantly higher odds of surviving (OR=17.5, 95% CI 1.9 to 161.5), favorable GOS (OR=4.2, 95% CI 1.2 to 14.8), and favorable 90-day mRS (OR=4.2, 95% CI 1.2 to 14.8).
  
  
  CONCLUSIONS
  SVAT is safe, with the majority of patients achieving good clinical outcome. Patients with lower Hunt and Hess grades have higher odds of surviving and favorable clinical prognosis.
authors: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Doniel
authors: D
authors: Drazin
authors: Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA.
authors: Vernard S
authors: VS
authors: Fennell
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
authors: Edward
authors: E
authors: Gifford
authors: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Carlito
authors: C
authors: Lagman
authors: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors: Kunakorn
authors: K
authors: Atchaneeyasakul
authors: Departments of Surgery and Neurology, Saint Louis University, St. Louis, Missouri, USA.
authors: Randall C
authors: RC
authors: Edgell
authors: Department of Neurology, Wayne State University, Detroit, Michigan, USA.
authors: Mahmoud
authors: M
authors: Rayes
authors: Michigan Head & Spine Institute, Clinton, Michigan, USA.
authors: Andrew
authors: A
authors: Xavier
authors: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Muhammad S
authors: MS
authors: Hussain
authors: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Rishi
authors: R
authors: Gupta
authors: Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors: Junaid S
authors: JS
authors: Kalia
authors: Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors: Osama O
authors: OO
authors: Zaidat
authors: Department of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA.
authors: Italo
authors: I
authors: Linfante
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors: Raul G
authors: RG
authors: Nogueira
authors: Department of Neurology, Boston University, Boston, Massachusetts, USA.
authors: Thanh
authors: T
authors: Nguyen
authors: Department of Neurology, University of Bahia, Salvador, Brazil.
authors: Jamary
authors: J
authors: Oliveira-Filho
authors: Department of Neurology, University of Bahia, Salvador, Brazil.
authors: Alexandre D M
authors: AD
authors: Barros
authors: Department of Neurology, Albany Medical College, Albany, New York, USA.
authors: Alan
authors: A
authors: Boulos
authors: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Michael J
authors: MJ
authors: Alexander
authors: Department of Neurology, Albany Medical College, Albany, New York, USA.
authors: Dileep R
authors: DR
authors: Yavagal
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*
keywords: Aneurysm; Balloon; Embolic; Hemorrhage; Subarachnoid