Abstract 1122‐000049: Safety and Efficacy of Daily Intra‐Arterial Endovascular Therapy for Refractory Cerebral Vasospasm Following Subarachnoid Hemorrhage

Abstract

Introduction : Delayed cerebral ischemia (DCI) and cerebral infarction (CI) due to vasospasm is a major cause of death and disability after aneurysmal subarachnoid hemorrhage (aSAH). Transluminal balloon angioplasty (BA) and super‐selective intra‐arterial (IA) infusion of vasodilators are considered for refractory vasospasm. We examined the safety and efficacy of repeated daily IA treatment in vasospasm. Methods : We reviewed records a single center of vasospasm treatment for aSAH from 2016 through 2019. Primary endpoints were rate of cerebral infarctions and safety related to daily treatments. Secondary endpoints were mortality and favorable clinical outcome at hospital discharge defined as modified Rankin scale of scores 0–2. Results : Of 426 patients with SAH, 197 were aneurysmal with 79 with DCI. Forty‐five out of 79 underwent IA treatment, of which 14 underwent 1 or 2 treatments (Group 1) and 31 underwent ≥3 treatments (Group2). Incidence of CI were similar (Group 1: 42.8%; Group 2: 54.8%, p = 0.45) Good clinical outcomes at discharge were seen in 36% in Group 1 and 16% in Group 2 (p = 0.15). Mortality was 7% in group 1 and 26% in group 2 (p = 0.17). Conclusions : Complications including vessel dissection, systemic hypotension and seizures did not increase with repeated treatments. CI was not noted to differ, but the outcomes were worse in group 2 which may relate to severity of SAH rather than DCI.