Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Early Vasospasm after Aneurysmal Subarachnoid Hemorrhage Predicts the Occurrence and Severity of Symptomatic Vasospasm and Delayed Cerebral Ischemia

Jabbarli R.a, e · Reinhard M.b · Shah M.a · Roelz R.a · Niesen W.-D.b · Kaier K.c · Taschner C.d · Weyerbrock A.a · Van Velthoven V.a, f

Author affiliations

aDepartment of Neurosurgery, bDepartment of Neurology, cInstitute for Medical Biometry and Medical Informatics, and dDepartment of Neuroradiology, University Medical Center Freiburg, Freiburg im Breisgau, and eDepartment of Neurosurgery, University Hospital Essen, Essen, Germany; fDepartment of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium

Related Articles for ""

Cerebrovasc Dis 2016;41:265-272

Do you have an account?

Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 10, 2015
Accepted: December 30, 2015
Published online: February 03, 2016
Issue release date: April 2016

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Background: Cerebral vasospasm usually develops several days after subarachnoid hemorrhage (SAH) and is generally acknowledged as a strong outcome predictor. In contrast, much less is known about the nature and eventual consequences of early angiographic vasospasm (EAVS) seen on admission digital subtraction angiography (DSA). Therefore, we aimed at identifying the risk factors and clinical impact of EAVS after SAH. Methods: Five hundred and thirty-one SAH patients with admission DSA performed within 72 h after the bleeding event were selected from a comprehensive database containing all consecutive SAH patients treated at our institution between January 2005 and December 2012. Predictors of EAVS, as well as associations between EAVS and delayed vasospasm-related complications, and unfavorable outcome (defined as modified Rankin scale >3) were evaluated in univariate and multivariate analyses. Results: EAVS was seen on 60 DSAs (11.3%) and was independently correlated with delayed symptomatic vasospasm requiring intra-arterial spasmolysis (OR 5.24, p < 0.0001), angioplasty (OR 2.56, p = 0.015) and repetitive endovascular treatment (OR 4.71, p < 0.0001). EAVS also increased the risk for multiple versus single territorial infarction on the follow-up CT scan(s) (OR 2.04, p = 0.047) and independently predicted unfavorable outcome (OR 2.93, p = 0.008). The presence of radiographic signs suspicious for fibromuscular dysplasia were independently associated with the occurrence of EAVS (OR 2.98, p = 0.026) and the need for repetitive endovascular vasospasm treatment (OR 3.95, p = 0.019). Conclusions: In view of the strong correlation with delayed symptomatic vasospasm and its ischemic complications, EAVS can be considered an alerting signal for severe symptomatic vasospasm. Therefore, more attention should be paid to the presence of EAVS on admission DSA.

© 2016 S. Karger AG, Basel


References

  1. Ecker A, Riemenschneider PA: Arteriographic evidence of spasm in cerebral vascular disorders. Neurology 1953;3:495-502.
  2. Loch Macdonald R: Vasospasm: my first 25 years-what worked? What didn't? What next? Acta Neurochir Suppl 2015;120:1-10.
    External Resources
  3. Heros RC, Zervas NT, Varsos V: Cerebral vasospasm after subarachnoid hemorrhage: an update. Ann Neurol 1983;14:599-608.
  4. Crowley RW, Medel R, Dumont AS, Ilodigwe D, Kassell NF, Mayer SA, Ruefenacht D, Schmiedek P, Weidauer S, Pasqualin A, Macdonald RL: Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke 2011;42:919-923.
  5. Adamczyk P, He S, Amar AP, Mack WJ: Medical management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a review of current and emerging therapeutic interventions. Neurol Res Int 2013;2013:462491.
  6. Baldwin ME, Macdonald RL, Huo D, Novakovic RL, Goldenberg FD, Frank JI, Rosengart AJ: Early vasospasm on admission angiography in patients with aneurysmal subarachnoid hemorrhage is a predictor for in-hospital complications and poor outcome. Stroke 2004;35:2506-2511.
  7. Qureshi AI, Sung GY, Suri MA, Straw RN, Guterman LR, Hopkins LN: Prognostic value and determinants of ultraearly angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 1999;44:967-973; discussion 973-974.
  8. Schmidt JM, Rincon F, Fernandez A, Resor C, Kowalski RG, Claassen J, Connolly ES, Fitzsimmons BF, Mayer SA: Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care 2007;7:10-17.
  9. Jabbarli R, Reinhard M, Niesen WD, Roelz R, Shah M, Kaier K, Hippchen B, Taschner C, Van Velthoven V: Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage. Eur J Neurol 2015;22:941-947.
  10. Jabbarli R, Glasker S, Weber J, Taschner C, Olschewski M, Van Velthoven V: Predictors of severity of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2013;22:1332-1339.
  11. Jabbarli R, Reinhard M, Roelz R, Shah M, Niesen WD, Kaier K, Taschner C, Weyerbrock A, Van Velthoven V: Early identification of individuals at high risk for cerebral infarction after aneurysmal subarachnoid hemorrhage: the BEHAVIOR score. J Cereb Blood Flow Metab 2015;35:1587-1592.
  12. Hunt WE, Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968;28:14-20.
  13. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-607.
  14. Fisher CM, Kistler JP, Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980;6:1-9.
  15. Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB: Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 1982;143:91-96.
  16. Singla A, Villwock MR, Padalino D, Swarnkar A, Deshaies EM: Complications associated with management of aneurysmal subarachnoid hemorrhage in patients with fibromuscular dysplasia: case report and literature review. Surg Res Update 2013;1:2-7.
    External Resources
  17. Slovut DP, Olin JW: Fibromuscular dysplasia. N Engl J Med 2004;350:1862-1871.
  18. Castellano JM, Vaishnava P, Castillo JG, Anyanwu AC, Fuster V: Coronary vasospasm attributable to fibromuscular dysplasia: the long bridge to transplant. Circ Heart Fail 2013;6:e31-e32.
  19. Slavin RE, Saeki K, Bhagavan B, Maas AE: Segmental arterial mediolysis: a precursor to fibromuscular dysplasia? Mod Pathol 1995;8:287-294.
    External Resources
  20. Cooke JP: Endothelium-derived factors and peripheral vascular disease. Cardiovasc Clin 1992;22:3-17.
    External Resources
  21. Fuse T, Umezu M, Yamamoto M, Demura K, Nishikawa Y, Niwa Y: External carotid artery aneurysm developing after embolization of a ruptured posterior inferior cerebellar artery aneurysm in a patient with cervicocephalic fibromuscular dysplasia - case report. Neurol Med Chir (Tokyo) 2006;46:290-293.
  22. George B, Zerah M, Mourier KL, Gelbert F, Reizine D: Ruptured intracranial aneurysms. The influence of sex and fibromuscular dysplasia upon prognosis. Acta Neurochir (Wien) 1989;97:26-30.
  23. O'Shaughnessy BA, Eddleman C, Bendok BR, Parkinson RJ, Awad IA, Batjer HH: Ruptured superior cerebellar artery aneurysm in a child with bilateral fibromuscular hyperplasia of the renal arteries: case report and review of the literature. J Neurosurg 2005;102(3 suppl):338-341.
  24. Olin JW, Sealove BA: Diagnosis, management, and future developments of fibromuscular dysplasia. J Vasc Surg 2011;53:826-836.e1.
  25. Etminan N, Beseoglu K, Heiroth HJ, Turowski B, Steiger HJ, Hanggi D: Early perfusion computerized tomography imaging as a radiographic surrogate for delayed cerebral ischemia and functional outcome after subarachnoid hemorrhage. Stroke 2013;44:1260-1266.
  26. Tsuang FY, Chen JY, Lee CW, Li CH, Lee JE, Lai DM, Hu FC, Tu YK, Hsieh ST, Wang KC: Risk profile of patients with poor-grade aneurysmal subarachnoid hemorrhage using early perfusion computed tomography. World Neurosurg 2012;78:455-461.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 10, 2015
Accepted: December 30, 2015
Published online: February 03, 2016
Issue release date: April 2016

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.