Vasospasm-Related Death after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Case–Control Study

Khanafer, Ali; Bhogal, Pervinder; Hellstern, Victoria; Harmening, Christoph; Bäzner, Hansjörg; Ganslandt, Oliver; Henkes, Hans

doi:10.3390/jcm11164642

Cited by 6 publications

(3 citation statements)

References 48 publications

(62 reference statements)

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“…DACAA rupture is frequently associated with intracerebral hematoma in the frontal lobe and may be localized to either side ( 15 ). In a study by Khanafer et al ( 18 ), 50 of 1,064 (4.7%) cases of subarachnoid hemorrhage due to aneurysm rupture were found to directly result from ruptured DACAAs. In this subgroup, 15 of the patients (30%) were symptomatic because of vasospasm ( 18 ).…”

Section: Discussionmentioning

confidence: 97%

“…In a study by Khanafer et al ( 18 ), 50 of 1,064 (4.7%) cases of subarachnoid hemorrhage due to aneurysm rupture were found to directly result from ruptured DACAAs. In this subgroup, 15 of the patients (30%) were symptomatic because of vasospasm ( 18 ). Given the elevated likelihood of rupture and bleeding, treatment is always recommended for incidental DACAAs, despite their small size.…”

Section: Discussionmentioning

confidence: 97%

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Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study

Khanafer,

Henkes,

Cohen

et al. 2024

Front. Neurol.

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PurposeFlow-diverter (FD) stents have become an established treatment for intracranial aneurysms in recent years, but their use for aneurysms in distal cerebral vessels with small carrier vessel diameters remains controversial. This study describes the method and mid- and long-term outcomes of FD treatment of distal anterior cerebral artery aneurysms (DACAAs) at two neurointerventional centers, to elucidate this topic and provide more in-depth data.MethodsData for all patients at two neurointerventional centers who were treated with FDs for DACAAs in the pericallosal and supracallosal segment of the anterior cerebral artery were retrospectively analyzed. Data on periprocedural complications, and short-, mid- and long-term follow-up findings were recorded.ResultsForty-one patients were eligible for inclusion in the study. Three FD models were used, one of which had an anti-thrombotic coating. Two periprocedural complications (5%) occurred but did not cause a change in the mRS. In the long-term follow-up, at 29 months and beyond, 83% of assessable patients showed complete occlusion of the aneurysms without new neurological deficits.ConclusionFDs are a safe and effective treatment approach for DACAAs. This study indicated a low risk of complications, and high closure rates in short-, mid- and long-term follow-up.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study

Khanafer,

Henkes,

Cohen

et al. 2024

Front. Neurol.

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“…Vasospasm after SAH is common and diagnosed in up to 70% on angiography, whereas symptomatic VS with neurologic deterioration occurs in about 30% [9]. Vasospasm is a feared complication to aSAH and is associated with poorer outcome [25]. The pathophysiology of VS is a complex cascade of events that is not yet fully understood.…”

Section: Introductionmentioning

confidence: 99%

The impact of pre-ictal statin use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage

Andersen,

Western,

Sorteberg

et al. 2023

Acta Neurochir

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Background Pleiotropic effects of statins may be beneficial in alleviating cerebral vasospasm (VS) and improving outcome after aneurysmal subarachnoid hemorrhage (aSAH). Initiation of statin treatment at aSAH is not recommended; however, the effect of pre-ictal and continued statin use is not fully investigated. Methods Retrospective study comparing aSAH patients admitted in 2012 to 2021 with pre-ictal statin use versus those not using statins. Patient entry variables, radiological/sonological VS, symptomatic VS, and radiologically documented delayed cerebral ischemia (DCI) were registered. Outcome was scored in terms of mortality, modified Rankin score, Glasgow outcome score extended, and levels of fatigue. Patients were compared on group level and in a case–control design. Results We included 961 patients, with 204 (21.2%) statin users. Statin users were older and had more often hypertension. Severe radiological/sonological VS, symptomatic VS, and DCI were less frequent in statin users, and their length of stay was shorter. Mortality, functional outcome, and levels of fatigue were similar in both groups. When analyzing 89 pairs of statin users and non-statin users matched for age, aSAH severity, gender, and hypertension, we confirmed decreased radiological/sonological and symptomatic VS as well as shorter length of stay in statin users. They also had more often a favorable functional outcome and lower levels of fatigue. Conclusions Patients with pre-ictal and continued use of statins have a reduced occurrence of radiological/sonological and symptomatic VS, shorter length of stay, and more often favorable functional outcome, whereas mortality is similar to non-statin users. Even though larger multicenter studies with common, strict protocols for prevention, diagnosis, and treatment of vasospasm are needed to finally establish the value of statins in aSAH, continuation of pre-ictal statin use seems worthwhile.

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Is Stent Retraction to ReLieve Arterial Cerebral VaSospasm Caused by SAH (Stent-ReLACSS) Using PRELAX the Long-awaited Solution for Treatment of Posthemorrhagic Cerebral Vasospasm?

Khanafer,

von Gottberg,

Albiña-Palmarola

et al. 2024

Clin Neuroradiol

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Purpose Recent observational studies have indicated the efficacy of stent retriever devices for the treatment of posthemorrhagic cerebral vasospasm (CVS), both by deployment and on-site withdrawal into the microcatheter (stent angioplasty, SA) and deployment followed by retraction through the target vessel similar to thrombectomy (StentRetraction to reLieve Arterial Cerebral vaSospasm caused by SAH, Stent-ReLACSS). This article reports the findings with each application of pRESET and pRELAX in the treatment of CVS. Methods We retrospectively enrolled 25 patients with severe CVS following aneurysmal subarachnoid hemorrhage. For the SA group, a stent retriever or a pRELAX was temporarily deployed into a narrow vessel segment and retrieved into the microcatheter after 3 min. For the Stent-ReLACSS group, a pRELAX was temporarily deployed into a narrow vessel and pulled back unfolded into the internal carotid artery. If intra-arterial vasodilators were administered, they were given exclusively after mechanical vasospasmolysis to maximize the effectiveness of the stent treatment. Results In this study fifteen patients and 49 vessels were treated with SA. All were technically successful without periprocedural complications; however, 8/15 patients (53.3%) required additional treatment of the CVS. A total of 10 patients and 23 vessel segments were treated with Stent-ReLACSS. All maneuvers were technically successful without periprocedural complications and all vessels showed significant angiographic improvement. No recurrent CVS requiring further endovascular treatment occurred in-hospital, and neither territorial ischemia in the treated vessels nor vascular injury were observed in follow-up angiography. Conclusion Based on the presented data it appears that Stent-ReLACSS with pRELAX does not pose any additional risks when used to treat CVS and might be superior to SA, especially concerning mid-term and long-term efficacy. The mechanism of action may be an effect on the endothelium rather than mechanical vasodilation. As many patients with CVS are diagnosed too late, prophylactic treatment of high-risk patients (e.g., poor grade, young, female) is potentially viable.

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Vasospasm-Related Death after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Case–Control Study

Cited by 6 publications

References 48 publications

Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study

Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study

The impact of pre-ictal statin use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage

Is Stent Retraction to ReLieve Arterial Cerebral VaSospasm Caused by SAH (Stent-ReLACSS) Using PRELAX the Long-awaited Solution for Treatment of Posthemorrhagic Cerebral Vasospasm?

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