Evaluation of cerebral vasospasm after early surgical and endovascular treatment of ruptured intracranial aneurysms

Neurosurgery. 1998 Feb;42(2):258-67; discussion 267-8. doi: 10.1097/00006123-199802000-00032.


Objective: To document the influence of the treatment modality (early surgery versus early endovascular treatment) on measures of cerebral vasospasm in a nonrandomized series of 156 patients treated within 72 hours of aneurysmal subarachnoid hemorrhage.

Methods: The following parameters were prospectively collected in a computerized data base and retrospectively analyzed for association with vasospasm-related ischemic infarctions: 1) Hunt and Hess (H&H) grade, 2) Fisher grade, 3) highest mean cerebral blood flow velocity (CBFVMAX) and maximum percent change in mean CBFV (%deltaCBFV) as recorded by transcranial Doppler ultrasound, 4) incidence of repeat subarachnoid hemorrhage, 5) incidence of delayed ischemic neurological deficits, 6) incidence of delayed ischemic infarctions, and 7) Glasgow Outcome Scale score.

Results: Forty-one patients (26.3%) suffered ischemic infarctions. The ischemic infarction rate was correlated with higher H&H grade (P = 0.002), higher Fisher grade (P = 0.05), higher CBFVMAX (P < 0.001) and %deltaCBFV (P = 0.01), occurrence of repeat subarachnoid hemorrhage, occurrence of delayed ischemic neurological deficits, and endovascular treatment (P = 0.02).

Conclusion: The infarction rate was higher with endovascular treatment versus surgery (37.7 versus 21.6%), as a result of a skewed Fisher Grade 4 infarction pattern in the endovascular treatment group versus the surgery treatment group (66.7 versus 24.5%). We suspect that unremoved subarachnoid/intracerebral clots contributed to the higher infarction rate with endovascular treatment. When patients with Fisher Grade 4 and H&H Grade V were excluded from analysis, the difference in infarct incidence between the treatment groups no longer reached statistical significance (Fisher Grades 1-3, P = 0.49; H&H Grades I-IV, P = 0.96).

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / surgery
  • Aneurysm, Ruptured / therapy*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / etiology
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / etiology
  • Embolization, Therapeutic* / instrumentation
  • Embolization, Therapeutic* / methods
  • Female
  • Humans
  • Incidence
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / surgery
  • Intracranial Aneurysm / therapy*
  • Ischemic Attack, Transient / diagnosis*
  • Ischemic Attack, Transient / physiopathology
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis*
  • Prospective Studies
  • Recurrence
  • Retrospective Studies
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / etiology
  • Tomography, X-Ray Computed