Document Detail

Timing of symptomatic vasospasm in aneurysmal subarachnoid hemorrhage: the effect of treatment modality and clinical implications.
MedLine Citation:
PMID:  20189086     Owner:  NLM     Status:  MEDLINE    
A better prediction of the time course of symptomatic vasospasm (SVSP) might have a significant impact on the management and prevention of delayed neurologic ischemic deficit (DIND). We studied the influence of the treatment for ruptured aneurysm on SVSP timing. We retrospectively analyzed data of consecutive patients with aneurysmal subarachnoid hemorrhage (aSAH) admitted in our center between 1999 and 2005, treated within 72 hours of the rupture by surgical clipping or endovascular coiling and in accordance with our neuroscience unit protocol. We analyzed the presence of SVSP and recorded the timing of occurrence after the aneurysmal repair intervention. Data on demographics, premorbid conditions, time elapsed from the subarachnoid hemorrhage onset and intervention, and clinical and radiologic characteristics at admission were collected. The first occurrence of postintervention SVSP was recorded and compared between the 2 treatment groups using a proportional hazards regression model, including significant covariates. Of the 67 patients analyzed, 21 (31%) underwent endovascular coiling and 46 (69%) underwent surgical clipping. The baseline variables were similar in the 2 groups. The median time from the procedure to clinical vasospasm was 4 days in the coiled patients and 7 days in the clipped patients. In a proportional hazards model regression analysis including age, sex, Fisher and Hunt-Hess grades, time between onset to procedure, and intervention type, only intervention type emerged as a significant predictor of time to SVSP after intervention (likelihood ratio chi2 = 16.8; P < .00). Treatment modality of ruptured intracranial aneurysm may influence the timing of SVSP occurrence.
Catalina C Ionita; John Baker; Carmelo Graffagnino; Michael J Alexander; Allan H Friedman; Osama O Zaidat
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  19     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-01     Completed Date:  2010-06-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  110-5     Citation Subset:  IM    
Copyright Information:
Copyright 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Department of Neurology, Stroke/Neurocritical Care Division, Catholic Health System, Buffalo, New York, USA.
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MeSH Terms
Aged, 80 and over
Brain Ischemia / etiology,  physiopathology,  prevention & control
Cerebral Arteries / pathology,  physiopathology,  radiography
Embolization, Therapeutic / methods,  statistics & numerical data*
Emergency Treatment / methods,  statistics & numerical data
Middle Aged
Outcome Assessment (Health Care)
Prospective Studies
Prostheses and Implants
Retrospective Studies
Subarachnoid Hemorrhage / complications,  radiography,  therapy*
Surgical Instruments
Time Factors
Treatment Outcome
Vascular Surgical Procedures / methods,  statistics & numerical data*
Vasospasm, Intracranial / etiology,  physiopathology*,  radiography
Young Adult

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