Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Abstract

Vasospasm, initial neurological damage, rebleeding, and periprocedural complications are associated prognostic factors for clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH). In this study, factors related to delayed ischemic neurological deficit (DIND) are evaluated using data from our institute for the last 18 years. Data from 2001 to 2018 of patients with aneurysmal SAH who underwent surgical clipping (SC) or endovascular coiling (EC) within 7 days of onset were retrospectively analyzed. Cases of mortality within 5 days after treatment were excluded. Multivariate analysis was used to identify the risk factors for DIND. In total, 840 cases of SAH were assessed; among these cases, 384 (45.7%) and 456 (54.3%) were treated with SC and EC, respectively. The frequency of DIND in the EC group was significantly less than that in the SC group (11.8% vs. 17.7%; p = 0.016). In the results of multivariate analysis, internal carotid artery (ICA) aneurysm and hemorrhagic complications were the risk factors for DIND. Cilostazol administration and EC were significant factors for vasospasm prevention after aneurysmal SAH (odds ratio of ICA aneurysm: 1.59, hemorrhagic complications: 1.76, SC: 1.51, and cilostazol administration: 0.51, respectively). Cilostazol administration was also a significant factor in patients who were treated with EC. ICA aneurysm, treatment strategy, hemorrhagic complications, and cilostazol administration were associated with DIND. Oral administration of cilostazol and avoiding hemorrhagic complications were effective in DIND prevention. If both treatments are available for ruptured aneurysms, clinicians should choose EC on the basis of its ability to prevent DIND.

Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-Grade Subarachnoid Hemorrhage: A Registry Study in Japan

“…This result may be related to SC reportedly being associated with more angiographic vasospasms and ischemic neurological deficits compared with EC. 36,37 Therefore, WFNS grade IV and Fisher CT grade 3 may be relatively more suited to EC than SC based on these results.…”

Japanese nationwide questionnaire survey on delayed cerebral infarction due to vasospasm after subarachnoid hemorrhage

“…In Japan, many hospitals use multiple prophylactic drugs, especially cilostazol, which has recently become more common. Cilostazol is the most potent vasodilator among antiplatelet agents and is increasingly considered effective against cerebral vasospasm (13,(16)(17)(18)(19)(20)(21)(22)(23)(24). The preventive effect of cilostazol on cerebral vasospasm has been demonstrated in several RCTs (16,18,20), systematic review and meta-analysis articles (19,(21)(22)(23)(24).…”