Cerebral vasospasm patterns following aneurysmal subarachnoid hemorrhage: an angiographic study comparing coils with clips

Jones, Jesse; Sayre, James W.; Chang, Raymond J; Tian, Jun-Ru; Szeder, Viktor; Gonzalez, Nestor R.; Jahan, Reza; Viñuela, Fernando; Duckwiler, Gary; Tateshima, Satoshi

doi:10.1136/neurintsurg-2014-011374

Cited by 22 publications

(12 citation statements)

References 27 publications

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“…Although we were not able to reliably draw statistical conclusions, two other factors suggest less CV risk for the Fisher 2 patients in this cohort: (i) none of the seven Fisher 2 patients had DCI and (ii) the lack of CV diagnostic imaging studies performed in these patients imply that there was no clinical need. With respect to aneurysm size and treatment modality, previous studies have shown conflicting evidence regarding the risk for CV (31)(32)(33)(34)(35)(36). Here, we found a correlation between coiling and increased CV, which is in contradiction to larger studies that demonstrate no difference between groups or favor coiling for lower risk (31,32,35,36).…”

Section: Discussioncontrasting

confidence: 99%

“…With respect to aneurysm size and treatment modality, previous studies have shown conflicting evidence regarding the risk for CV (31)(32)(33)(34)(35)(36). Here, we found a correlation between coiling and increased CV, which is in contradiction to larger studies that demonstrate no difference between groups or favor coiling for lower risk (31,32,35,36). We are uncertain of why coiled patients in this study tended to have more CV, although we cannot exclude that those patients less prone to CV were more often surgically clipped.…”

Section: Discussioncontrasting

confidence: 99%

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Haptoglobin phenotype predicts the development of focal and global cerebral vasospasm and may influence outcomes after aneurysmal subarachnoid hemorrhage

Leclerc

Blackburn

Neal

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

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Cerebral vasospasm (CV) and the resulting delayed cerebral ischemia (DCI) significantly contribute to poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Free hemoglobin (Hb) within the subarachnoid space has been implicated in the pathogenesis of CV. Haptoglobin (Hp) binds free pro-oxidant Hb, thereby modulating its harmful effects. Humans can be of three Hp phenotypes: Hp1-1, Hp2-1, or Hp2-2. In several disease states, the Hp2-2 protein has been associated with reduced ability to protect against toxic free Hb. We hypothesized that individuals with the Hp2-2 phenotype would have more CV, DCI, mortality, and worse functional outcomes after aSAH. In a sample of 74 aSAH patients, Hp2-2 phenotype was significantly associated with increased focal moderate (P = 0.014) and severe (P = 0.008) CV and more global CV (P = 0.014) after controlling for covariates. Strong trends toward increased mortality (P = 0.079) and worse functional outcomes were seen for the Hp2-2 patients with modified Rankin scale at 6 wk (P = 0.076) and at 1 y (P = 0.051) and with Glasgow Outcome Scale Extended at discharge (P = 0.091) and at 1 y (P = 0.055). In conclusion, Hp2-2 phenotype is an independent risk factor for the development of both focal and global CV and also predicts poor functional outcomes and mortality after aSAH. Hp phenotyping may serve as a clinically useful tool in the critical care management of aSAH patients by allowing for early prediction of those patients who require increased vigilance due to their inherent genetic risk for the development of CV and resulting DCI and poor outcomes.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Haptoglobin phenotype predicts the development of focal and global cerebral vasospasm and may influence outcomes after aneurysmal subarachnoid hemorrhage

Leclerc

Blackburn

Neal

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

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“…This seems to be related to a varying cerebrospinal fluid circulation for carrying away blood degradation products, presumably depending on the method of treatment. 21 The impact on the clinical course has yet to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Cerebral Vasospasm after Spontaneous Subarachnoid Hemorrhage: Comparison of Single and Multiple Intra-arterial Treatment with Respect to the Functional Outcome

Neumann

Ditz

Schacht

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Objective In cases of spontaneous subarachnoid hemorrhage (sSAH) and symptomatic cerebral vasospasm (sCVS), multiple intra-arterial treatments (IATs) can be potentially useful for the functional outcome, even if the prognosis is initially poor. But the actual influence of the number of IATs has yet to be clarified. We wanted to assess if there are differences in the functional outcome between patients with a singular IAT and multiple IATs for sCVS after sSAH. Methods In a single-center study, 405 consecutive patients with nontraumatic SAH were analyzed retrospectively. A total of 126 developed sCVS, and 86 received IAT (32 singular and 54 multiple, i.e., more than one) with nimodipine with or without percutaneous transluminal angioplasty (PTA). Both groups were compared for demographic data, initial treatment (clipping or endovascular), and initial grading (World Federation of Neurosurgical Societies/Fisher classification, intraventricular hemorrhage, and intracerebral hemorrhage). The modified Rankin Scale (mRS) was used to assess functional outcome at the time of discharge and after 3 and 6 months. The development of CVS-associated infarction was assessed by computed tomography (CT). Categorical variables of the patient groups were analyzed in contingency tables using the Fisher exact test, chi-square test, and the Mann-Whitney U test. Statistical significance was accepted at p < 0.05. Results Patient groups with singular and multiple IATs were comparable concerning demographic data and initial grading. At the end of follow-up after 6 months, both groups showed comparable functional outcomes. A favorable outcome (mRS: 0–3) was observed in 14 of 26 patients (53.9%) with a single IAT and for 29 of 49 patients (59.2%) with multiple IATs. An unfavorable outcome (mRS: 4–6) occurred in 12 of 26 patients (46.1%) with a single IAT and for 20 of 49 patients (40.8%) with multiple IATs (p = 0.420). In the group with a single IAT, 22 of 32 patients (68.8%) developed CVS-associated infarction; 32 of 54 patients (59.3%) showed brain infarcts after multiple IATs (p = 0.259). Conclusion For patients with sCVS after sSAH, multiple IATs (nimodipine with or without additional PTA) can be applied safely because no significant differences in functional outcome were observed compared with a singular IAT. We conclude that patients should be treated repeatedly if vasospasm reoccurs.

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“…Jones et al analyzed the pathogenesis of cerebral vasospasm, and reported the process of SAH washout. 12) According to their study, cerebral vasospasm around a treated aneurysm remained after clipping, whereas it gradually migrated to a distal blood vessel after coiling. This suggests that coiling does not affect cerebrospinal fluid circulation, facilitating the spontaneous washout of SAH along this circulation.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Vasospasm and Patient Outcome after Coiling or Clipping for Intracranial Aneurysmal Subarachnoid Hemorrhage

Shimoda

Kamiya

Kano

et al. 2019

JNET

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It is still controversial whether coiling or clipping has a lower incidence of cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH). In this study, we compared angiographic vasospasm (AV), symptomatic vasospasm (SV), and the outcome of both procedures for ruptured cerebral aneurysms. Methods: From 2007 to 2018, 127 patients were coiled and 127 were clipped for ruptured cerebral aneurysms. We retrospectively reviewed AV, SV, and the outcome of both procedures. Results: The incidence of AV was 32 (25%) patients for coiling and 59 (46%) patients for clipping. SV occurred in eight (6%) patients for coiling and 19 (15%) patients for clipping, and was significantly less in the coiling group. A favorable outcome (modified Rankin scale [mRS] 0-2 on discharge) was in 71 (56%) patients for coiling and 77 (61%) patients for clipping, and there was no significant difference between the two groups. Conclusion: The incidence of SV was significantly less in the coiling group for ruptured cerebral aneurysms. Even if SV occurred following aneurysmal SAH, early therapeutic intervention may prevent deterioration of the outcome. Keywords▶ coil embolization, symptomatic vasospasm, aneurysmal subarachnoid hemorrhage This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Cerebral vasospasm patterns following aneurysmal subarachnoid hemorrhage: an angiographic study comparing coils with clips

Cited by 22 publications

References 27 publications

Haptoglobin phenotype predicts the development of focal and global cerebral vasospasm and may influence outcomes after aneurysmal subarachnoid hemorrhage

Haptoglobin phenotype predicts the development of focal and global cerebral vasospasm and may influence outcomes after aneurysmal subarachnoid hemorrhage

Symptomatic Cerebral Vasospasm after Spontaneous Subarachnoid Hemorrhage: Comparison of Single and Multiple Intra-arterial Treatment with Respect to the Functional Outcome

Cerebral Vasospasm and Patient Outcome after Coiling or Clipping for Intracranial Aneurysmal Subarachnoid Hemorrhage

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