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DOI: 10.1055/s-0035-1564497
Prevalence of Cerebral Vasospasm, Management, and Clinical Outcome after Aneurysmal Subarachnoid Hemorrhage (aSAH): A Four-Year Survey in Geneva
Objective: We prospectively evaluated the prevalence and impact of vasospasm in patients presenting with aSAH. Methods: We evaluated 213 patients admitted consecutively in Geneva University Hospital with aSAH between 2009 and 2013. Age, gender, WFNS grade, Fisher score, treatment received for the ruptured aneurysm (surgical vs. endovascular), and prevalence of vasospasm using clinical and radiological scales were recorded. Outcome was assessed at discharge using the modified Rankin scale (mRs). To do so, a multivariate analysis was performed. Results: Vasospasm was observed in 38.1% (N = 87) of patients suffering aSAH. The distribution of patients according to their WFNS and Fisher scores at admission was similar to those previously reported in the literature. Among patients presenting a vasospasm, 39 (45%) received medical treatment only (observation in the ICU and controlled hypertensive therapy), 48 (55%) received medical combined with endovascular treatment (balloon dilation: 20.7%; chemical dilation: 18.4%; both: 16.1%). Vasospasm occurrence significantly correlated with the Fisher score (p = 0.048) and seems to be associated with WFNS (p = 0.075). Overall, patients affected by vasospasm have a worst outcome than others (median [95% CI]: 1 [1–2] vs. 3 [2–3], p < 0.004). Despite care and aggressive treatment, vasospasm significantly deteriorates the prognosis of WFNS I patients (no vasospasm [N = 65] vs. vasospasm [N = 22]: mRs, mean [95% CI] 1.12 [0.78–1.46] vs. 2.64 [2.06–3.21], p < 0.0001). Nevertheless, age remains a significant confounding prognostic factor in this latter group (r = 0.24; p < 0.03). Conclusions: Vasospasm occurs in one-third of patients and is treated aggressively. General outcome correlates with WFNS at admission and age; however, this correlation is weaker in patients suffering vasospasm. A significant impact of vasospasm is only visible in WFNS I patients.