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Invasive Diagnostic and Therapeutic Management of Cerebral VasoSpasm after Aneurysmal Subarachnoid Hemorrhage

Hartmut Vatter1, Erdem Güresir1, Ralph König2

  • 1Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.

Journal of Clinical Medicine
|October 27, 2022
PubMed

Insights

Conservative therapy for cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) showed better patient outcomes than invasive endovascular treatment. This study found no difference in delayed cerebral ischemia (DCI) rates between the two approaches.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Cerebral vasospasm (CVS) is a significant complication following aneurysmal subarachnoid hemorrhage (SAH), often leading to delayed cerebral ischemia (DCI).
  • Invasive endovascular therapy is a common rescue treatment for CVS, but prospective data on its efficacy compared to conservative management is limited.

Purpose of the Study:

  • To prospectively evaluate the efficacy of invasive endovascular treatment versus conservative therapy for managing cerebral vasospasm (CVS) in patients with aneurysmal subarachnoid hemorrhage (SAH).
  • To compare the rates of delayed cerebral ischemia (DCI) and clinical outcomes at 6 months post-SAH between the treatment groups.

Main Methods:

  • A prospective, randomized, multicenter trial involving 34 patients diagnosed with relevant CVS onset after SAH.
  • Patients were randomized to either conservative therapy (n=18) or invasive endovascular treatment (n=16).
  • Outcomes, including DCI development (primary) and clinical status at 6 months (secondary), were assessed by a blinded neuroradiologist.

Main Results:

  • No significant difference in the rate of cerebral infarctions was observed between the conservative and endovascular treatment groups on initial or follow-up MRI.
  • Patients managed conservatively demonstrated significantly better clinical outcomes at 6 months post-SAH (mRs 2 ± 1.5 vs. 4 ± 1.8, p = 0.005).
  • Invasive endovascular treatment for CVS did not reduce DCI rates and was associated with potentially poorer outcomes compared to induced hypertension.

Conclusions:

  • Invasive endovascular treatment for cerebral vasospasm (CVS) following aneurysmal subarachnoid hemorrhage (SAH) does not appear to lower the incidence of delayed cerebral ischemia (DCI).
  • Conservative management, potentially including induced hypertension, may lead to better functional outcomes at 6 months compared to endovascular intervention.
  • Further research is warranted to identify specific patient subgroups who might benefit from endovascular treatment for CVS.

Keywords:
balloon angioplastydelayed ischemic neurological deficitintra-arterial spasmolysisintracranial aneurysmsubarachnoid hemorrhagetreatmentvasospasm

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