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Treatment Modality and Vasospasm After Aneurysmal Subarachnoid Hemorrhage.
MedLine Citation:
PMID:  23954735     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Vasospasm is the leading source of neurological morbidity after aneurysmal subarachnoid hemorrhage (SAH). Our objective is to evaluate the impact of treatment modality on vasospasm, delayed cerebral infarction and clinical deterioration due to delayed cerebral ischemia (CD-DCI).
METHODS: The authors reviewed an institutional cohort comparing rates of vasospasm, delayed cerebral infarction, and CD-DCI between patients managed with only microsurgical clipping and those treated with only endovascular coiling within 72 hours of rupture. Age, sex, smoking status, Hunt-Hess grade and Fisher grade were adjusted for in a multivariate regression model.
RESULTS: Two hundred and three patients were treated with clipping and fifty-two with coiling. There was no significant difference in patient age, sex, smoking status, aneurysm location, and presenting clinical (Hunt-Hess) and radiographic (Fisher) grade between these two groups. Sixty-percent of patients had moderate or severe vasospasm after clipping compared to 38% after coiling (Multivariate OR 2.32, 95% CI 1.21-4.47, p = 0.01). Clipping was associated with a greater number of territories with vasospasm (mean of 3.1 vs 2.3, p = 0.03 after multivariate analysis). Delayed radiographic cerebral infarction was more common in the clipping group (17% vs 6%, Multivariate OR 3.66, 95% CI 1.06-12.71, p = 0.04). For CD-DCI, a trend was seen as 16% of patients treated with clipping had CD-DCI compared to 6% of patients treated with coiling (Multivariate OR 3.11, 95% CI 0.89, 10.86, p = 0.07).
CONCLUSION: We demonstrate significantly lower rates of vasospasm and delayed infarction after endovascular coiling of ruptured aneurysms.
Authors:
Bradley A Gross; Pui Man Rosalind Lai; Kai U Frerichs; Rose du
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-14
Journal Detail:
Title:  World neurosurgery     Volume:  -     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-8-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 Elsevier Inc. All rights reserved.
Affiliation:
Department of Neurological Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115.
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