Clinical neurology and neurosurgery · 2026
Understanding late-window cerebral vasospasm in aneurysmal subarachnoid hemorrhage.
СтатьяНазвание и аннотация: Перевод в очереди
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Alwakaa Omar, Fodor Thomas, Devanney James, Metu Jeet, Filo Jean, Lau Tzak Ying, Regenhardt Robert W, Benitez Bruno A, Fehnel Corey R, Yoon Jason, Selim Magdy H, Taussky Philipp, Granstein Justin H, Ogilvy Christopher S, Das Alvin S
Аннотация
BACKGROUND AND OBJECTIVE: Cerebral vasospasm is a major determinant of neurologic outcome following aneurysmal subarachnoid hemorrhage (aSAH). While vasospasm typically occurs between days 3 and 10 after admission, a subset of patients develop vasospasm beyond this conventional window. The factors contributing to this late-window presentation remain poorly characterized. In this study, we sought to determine the incidence of late-window vasospasm and identify its independent clinical and radiographic predictors.
METHODS: Patients with cerebral vasospasm identified on transcranial Doppler or CT angiography were selected from a prospectively maintained database of patients with aSAH admitted between 2003 and 2024. Variables associated with late-window vasospasm (occurring > 10 days from symptom onset) at p < 0.05 in univariable analyses were subsequently entered into a multivariable logistic regression model to identify independent predictors.
RESULTS: Among 370 patients with aSAH, 192 (51.9%) were diagnosed with vasospasm (median age 54 years [IQR 46-62]; 123 female). Late-window vasospasm occurred in 27 patients (14.1%). In univariable analysis, female sex, smoking history, surgical aneurysm treatment, Fisher grade, and delayed aneurysm treatment (> 48 h after symptom onset) were significantly associated with late-window vasospasm. After multivariable adjustment, higher Fisher grade (aOR 2.34, 95% CI 1.30-4.24, p = 0.005) and delayed aneurysm treatment (aOR 8.86, 95% CI 2.98-26.36, p < 0.001) remained independent predictors. There were no significant differences in length of stay (24 vs. 20 days, p = 0.051) or poor functional outcome (modified Rankin scale [mRS] ≥ 3) at discharge (63.0% vs. 47.9%, p = 0.146) between patients with and without late-window vasospasm.
CONCLUSION: Approximately one in seven patients with vasospasm experienced onset beyond 10 days. Higher Fisher grade and delayed aneurysm treatment were independently associated with late-window vasospasm. These findings suggest continued neurovascular surveillance beyond the first 10 days may be important for patients with these risk factors.
METHODS: Patients with cerebral vasospasm identified on transcranial Doppler or CT angiography were selected from a prospectively maintained database of patients with aSAH admitted between 2003 and 2024. Variables associated with late-window vasospasm (occurring > 10 days from symptom onset) at p < 0.05 in univariable analyses were subsequently entered into a multivariable logistic regression model to identify independent predictors.
RESULTS: Among 370 patients with aSAH, 192 (51.9%) were diagnosed with vasospasm (median age 54 years [IQR 46-62]; 123 female). Late-window vasospasm occurred in 27 patients (14.1%). In univariable analysis, female sex, smoking history, surgical aneurysm treatment, Fisher grade, and delayed aneurysm treatment (> 48 h after symptom onset) were significantly associated with late-window vasospasm. After multivariable adjustment, higher Fisher grade (aOR 2.34, 95% CI 1.30-4.24, p = 0.005) and delayed aneurysm treatment (aOR 8.86, 95% CI 2.98-26.36, p < 0.001) remained independent predictors. There were no significant differences in length of stay (24 vs. 20 days, p = 0.051) or poor functional outcome (modified Rankin scale [mRS] ≥ 3) at discharge (63.0% vs. 47.9%, p = 0.146) between patients with and without late-window vasospasm.
CONCLUSION: Approximately one in seven patients with vasospasm experienced onset beyond 10 days. Higher Fisher grade and delayed aneurysm treatment were independently associated with late-window vasospasm. These findings suggest continued neurovascular surveillance beyond the first 10 days may be important for patients with these risk factors.