Outcome analysis for patients with subarachnoid hemorrhage and vasospasm including endovascular treatment

Sina Burth; Jan Meis; Dorothea Kronsteiner; Helena Heckhausen; Klaus Zweckberger; Meinhard Kieser; Wolfgang Wick; Christian Ulfert; Markus Möhlenbruch; Peter Ringleb; Silvia Schönenberger

doi:10.1186/s42466-023-00283-3

Outcome analysis for patients with subarachnoid hemorrhage and vasospasm including endovascular treatment

Neurol Res Pract. 2023 Nov 2;5(1):57. doi: 10.1186/s42466-023-00283-3.

Authors

Affiliations

¹ Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
² Institute of Medical Biometry, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
³ Departement of Neurosurgery, Städtisches Klinikum Braunschweig gGmbH, Salzdahlumer Street 90, 38126, Braunschweig, Germany.
⁴ DKFZ Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.
⁵ German Cancer Consortium (DKTK) and Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁶ Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
⁷ Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. Silvia.Schoenenberger@med.uni-heidelberg.de.

Abstract

As a complication of subarachnoid hemorrhage (SAH), vasospasm substantially contributes to its morbidity and mortality. We aimed at analyzing predictors of outcome for these patients including the role of endovascular treatment (ET). Our database was screened for patients with SAH treated in our Neuro-ICU from 2009 to 2019. Clinical parameters including functional outcome (modified Rankin Scale, mRS of 0-2 or 3-6 at discharge and after a median follow-up of 18 months) and details about ET were gathered on 465 patients, 241 (52%) of whom experienced vasospasm. Descriptive analyses were performed to identify explanatory variables for the dichotomized mRS score. A logistic regression model was fitted on 241 patients with vasospasm including age, Hunt and Hess Score, extraventricular drainage (EVD), forced hypertension, ET and delayed cerebral ischemia (DCI). The model found a Hunt and Hess Score of 5 (OR = 0.043, p = 0.008), requirement of EVD (OR = 0.161, p < 0.001), forced hypertension (OR = 0.242, p = 0.001), ET (OR = 0.431, p = 0.043) and DCI (OR = 0.229, p < 0.001) to be negative predictors of outcome while age was not. Use of intraarterial nimodipine alone (OR = 0.778, p = 0.705) or including balloon angioplasty (OR = 0.894, p = 0.902) and number of ETs per patient (OR = 0.757, p = 0.416) were not significant in a separate model with otherwise identical variables. While DCI is clearly associated with poor outcome, the influence of ET on outcome remains inconclusive. Limited by their retrospective nature and an indication bias, these data encourage a randomized assessment of ET.

Keywords: Delayed cerebral ischemia; Endovascular treatment; Outcome; Subarachnoid hemorrhage; Vasospasm.