Vasospasm-related complications after subarachnoid hemorrhage: the role of patients’ age and sex

Oppong, Marvin Darkwah; Iannaccone, Antonella; Gembruch, Oliver; Pierscianek, Daniela; Chihi, Mehdi; Dammann, Philipp; Köninger, Angela; Müller, Oliver; Forsting, Michael; Sure, Ulrich; Jabbarli, Ramazan

doi:10.1007/s00701-018-3549-1

Cited by 34 publications

(27 citation statements)

References 49 publications

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“…Arguably, a higher percentage of brain atrophy in older patients would explain the lower level of cerebral edema, thus accounting for our findings. Other indicators such as smoking, hypertension, diabetes mellitus, and hydrocephalus were not found to be significantly related to subsequent CI occurrence in our univariate analysis, which is in line with the results of previous studies that have not shown strong relationships of these factors with CI incidence [18,[21][22][23].…”

Section: Other Factors Influencing Ebi Resolutionsupporting

confidence: 91%

Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?

Torné

Hoyos

Llull

et al. 2021

JCM

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Background: The level of consciousness and cerebral edema are among the indicators that best define the intensity of early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). Although these indicators are usually altered in patients with a poor neurological status, their usefulness for selecting patients at risk of cerebral infarction (CI) is not well established. Furthermore, little is known about the evolution of these indicators during the first week of post-ictal events. Our study focused on describing the association of the longitudinal course of these predictors with CI occurrence in patients with severe aSAH. Methods: Out of 265 aSAH patients admitted consecutively to the same institution, 80 patients with initial poor neurological status (WFNS 4–5) were retrospectively identified. After excluding 25 patients with early mortality, a total of 47 patients who underwent early CT (<3 days) and late CT (<7 days) acquisitions were included in the study. Early cerebral edema and delayed cerebral edema were calculated using the SEBES score, and the level of consciousness was recorded daily during the first week using the Glasgow Coma Scale (GCS). Results: There was a significant improvement in the SEBES (Early-SEBES median (IQR) = 3 (2–4) versus Delayed-SEBES = 2 (1–3); p = 0.001) and in GCS scores (B = 0.32; 95% CI 0.15–0.49; p = 0.001) during the first week. When comparing the ROC curves of Delayed-SEBES vs Early-SEBES as predictors of CI, no significant differences were found (Early-SEBES Area Under the Curve: 0.65; Delayed-SEBES: 0.62; p = 0.17). Additionally, no differences were observed in the relationship between the improvement in the GCS across the first week and the occurrence of CI (p = 0.536). Conclusions: Edema and consciousness level improvement did not seem to be associated with the occurrence of CI in a surviving cohort of patients with severe aSAH. Our results suggest that intensive monitoring should not be reduced in patients with a poor neurological status regardless of an improvement in cerebral edema and level of consciousness during the first week after bleeding.

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Section: Other Factors Influencing Ebi Resolutionsupporting

confidence: 91%

Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?

Torné

Hoyos

Llull

et al. 2021

JCM

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“…The following variables were collected from the institutional observational SAH database and in‐house electronic medical records: age; clinical grade on admission according to the World Federation of Neurosurgical Societies (WFNS) scale [22]; presence of ICH on initial CT; treatment modality; DC timing (primary/secondary) and type (BFCE/HCE); functional outcome at discharge and 6 months after SAH; and conservative ICP management before and after DC. All CT scans up to 6 weeks after SAH were reviewed by the first author (R.J.) for the occurrence of new cerebral infarctions [23].…”

Section: Methodsmentioning

confidence: 99%

Size does matter: The role of decompressive craniectomy extent for outcome after aneurysmal subarachnoid hemorrhage

Jabbarli

Oppong

et al. 2021

Euro J of Neurology

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Background and purpose In previous studies in patients with traumatic brain injury and ischemic stroke, the size of decompressive craniectomy (DC) was reported to be paramount with regard to patient outcomes. We aimed to identify the impact of DC size on treatment results in individuals with aneurysmal subarachnoid hemorrhage (SAH). Methods The extent of DC in 232 patients with SAH who underwent bifrontal or hemicraniectomy between January 2003 and December 2015 was analyzed using semi‐automated surface measurements. The study endpoints were course of intracranial pressure (ICP) treatment after DC, occurrence of cerebral infarcts, in‐hospital mortality, and unfavorable outcome at 6 months (defined as modified Rankin scale score >3). The associations of DC size with the study endpoints were adjusted for DC timing, patient age, clinical and radiographic severity of SAH, aneurysm location, and treatment modality. Results The mean DC surface area was 100.9 (±45.8) cm2. In multivariate analysis, a large DC (>105 cm2) was independently associated with a lower risk of cerebral infarcts (adjusted odds ratio [aOR] 0.30, 95% confidence interval [CI] 0.16–0.56), in‐hospital mortality (aOR 0.28, 95% CI 0.14–0.56) and unfavorable outcome (aOR 0.51, 95% CI 0.27–0.98). Moreover, SAH patients with a small DC size (<75 cm2) were more likely to require prolonged (>3 days, aOR 3.60, 95% CI 1.37–9.42) and enhanced (aOR 2.31, 95% CI 1.12–4.74) postoperative ICP treatment. Conclusion This is the first study showing the impact of DC size on postoperative ICP control and patient outcome in the context of SAH; specifically, a large craniectomy flap (>105 cm2) might lead to better outcomes in SAH patients requiring decompressive surgery.

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“… 30 , 31 ) Although a recent 32 ) study reported that the aneurysm location did not affect the incidence of delayed cerebral infarction, female sex was reported to be an independent predictor of symptomatic vasospasm. 33 ) The present study had a significantly higher frequency of female patients with ICA aneurysms (ICA: 79.3% vs. others: 57.7%), and the high rate of DIND in ICA aneurysms may have been affected by these factors. In this study, we divided all the complications into two groups, namely, hemorrhagic and nonhemorrhagic complications, because we hypothesized that the increase of hematoma could induce vasospasm after radical treatment.…”

Section: Discussionmentioning

confidence: 48%

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Imamura

Tani

Adachi

et al. 2022

Neurol. Med. Chir.(Tokyo)

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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.

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Vasospasm-related complications after subarachnoid hemorrhage: the role of patients’ age and sex

Abstract: DRKS, Unique identifier: DRKS00008749.

Cited by 34 publications

References 49 publications

Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?

Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?

Size does matter: The role of decompressive craniectomy extent for outcome after aneurysmal subarachnoid hemorrhage

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

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