Does treatment modality affect vasospasm distribution in aneurysmal subarachnoid hemorrhage: differential use of intra-arterial interventions for cerebral vasospasm in surgical clipping and endovascular coiling populations.

OBJECT: Endovascular treatment of cerebral vasospasm consists primarily of transluminal balloon angioplasty (TBA) and intra-arterial (IA) vasodilator administration, the former restricted to use within the distal internal carotid and proximal intracerebral arteries. Our objective was to characterize clinical and angiographic features of those patients undergoing TBA and IA vasodilator treatments, particularly as it related to the aneurysm treatment modality.

METHODS

Retrospective analysis of consecutive patients admitted for aneurysmal SAH undergoing IA treatment for cerebral vasospasm (n=73) examining clinical and angiographic variables. Continuous and ordinal means were examined with Mann-Whitney and Student t tests while nominal values were examined with χ(2)/Fisher's exact tests. Multivariate logistic and linear regression included admission Glasgow coma scale, age, number of aneurysms and number of vasospastic vessels.

RESULTS

Those patients receiving IA vasodilator in isolation (n=16) were older (45.9 vs 59.1 years, p=0.001) and more frequently had vasospasm involving the anterior cerebral artery alone (0.0% vs 31.3%, p <0.001). The use of an IA vasodilator alone or in combination with TBA more frequently occurred in the coiled population (32.3% vs 50.1%, p=0.021).

CONCLUSION

TBA and IA vasodilators are safe and effective means to treat cerebral vasospasm. Their use for proximal and distal vasospasm, respectively, and in tandem for diffuse disease, suggests regional differences in cerebral vasospasm between surgical clipping and endovascular coiling populations with coiled patients more often having distal vasospasm. Craniotomy and/or hemorrhagic evacuation performed during open surgery may contribute to this difference.