Impact of basilar artery vasospasm on outcome in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage

被引:18
作者
Sviri, Gill E. [1 ]
Newell, David W.
Lewis, David H.
Douville, Colleen
Ghodke, Basavaraj
Chowdhary, Minku
Lam, Arthur M.
Haynor, David
Zaaroor, Menashe
Britz, Gavin W.
机构
[1] Rambam Maimonides Med Ctr, Dept Neurosurg, Haifa, Israel
[2] Seattle Neurosci Inst, Swedish Med Ctr, Seattle, WA USA
[3] Univ Washington, Harborview Med Ctr, Dept Neurol Surg, Seattle, WA 98195 USA
[4] Univ Washington, Harborview Med Ctr, Dept Radiol, Seattle, WA 98195 USA
[5] Univ Washington, Harborview Med Ctr, Dept Anesthesiol, Seattle, WA 98195 USA
关键词
angiography; basilar artery; cerebral blood flow; single-photon emission computed tomography; subarachnoid hemorrhage; vasospasm;
D O I
10.1161/01.STR.0000244765.29502.85
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-The purpose of the present study was to evaluate the impact of basilar artery (BA) vasospasm on outcome in patients with severe vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). Methods-Sixty-five patients with clinically suspect severe cerebral vasospasm after aSAH underwent cerebral angiography before endovascular treatment. Vasospasm severity was assessed for each patient by transcranial Doppler measurements, angiography, and Tc-99m-ethylcysteinate dimer single-photon emission computed tomography (ECD-SPECT) imaging. Percentage of BA narrowing was calculated in reference to the baseline angiogram. Results-BA narrowing >= 25% was found in 23 of 65 patients, and delayed brain stem (BS) hypoperfusion, as estimated by ECD-SPECT, was found in 16. Fourteen of 23 patients with BA narrowing >= 25% experienced BS hypoperfusion, whereas only 2 of 42 patients with >= 25% BA narrowing experienced BS ischemia (P < 0.001). Stepwise logistic regression after adjusting for age with Hunt and Hess grade, Fisher grade, hydrocephalus, and aneurysmal location as covariables revealed BA narrowing >= 25% and delayed BS hypoperfusion to be significantly and independently associated with unfavorable 3-month outcome (P=0.0001; odds ratio, 10.1; 95% CI, 2.5 to 40.8; and P=0.007; odds ratio, 13.8, 95% CI, 2.18 to 91.9, respectively). Conclusions-These findings suggest for the first time that BA vasospasm after aSAH is an independent and significant prognostic factor associated with poor outcome in patients with severe cerebral vasospasm requiring endovascular therapy. Further study should be done to evaluate the role of interventional therapy on outcome in patients with posterior circulation vasospasm.
引用
收藏
页码:2738 / 2743
页数:6
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