Risk factors for angiographic vasospasm and delayed cerebral ischemia subsequent to aneurysmal subarachnoid...

Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality. Symptoms of DCI can be categorized as temporary or permanent; however, the relationship between DCI and angiographic vasospasm (AVS) remains unclear. Therefore, this study aimed to clarify the relationship between DCI and AVS and to identify the factors associated with DCI in patients with aSAH.

Data from patients with acute aSAH who underwent surgical clipping or endovascular coiling within 72 h of onset in Japan between December 2016 and December 2020, were analyzed retrospectively. Univariable and multivariable logistic regression analyses were performed to identify factors associated with temporary or permanent DCI and AVS.

AVS was identified in 27.3 % of 1066 patients with aSAH. Among these, 65.8 % did not develop DCI. DCI occurred in 13.4 % of patients, and 37.3 % of those with DCI did not experience AVS. AVS was associated with both temporary and permanent DCI in multivariable logistic regression analyses. Older age was associated with permanent DCI. Poor outcomes (defined as a modified Rankin Scale score of 3-6) at discharge were also associated with permanent (OR: 7.51, 95 % CI: 3.12-22.31) but not with temporary DCI or AVS.

Although AVS was significantly associated with both temporary and permanent DCI, DCI can occur without AVS. Older age was a risk factor for permanent DCI, which was associated with poor outcomes. This study may suggest the importance of management for DCI particularly in older patients.