The course of spontaneous subarachnoid hemorrhage: Risk factors for recurrence of cerebral vasospasm and related infarction after transluminal balloon angioplasty as a local treatment option

Zielsetzung After spontaneous subarachnoid hemorrhage (sSAH), cerebral vasospasm (CVS) is a common complication, potentially resulting in infarction mainly responsible for a poor outcome. Besides established intra-arterial vasodilators, the precise impact of transluminal balloon angioplasty (TBA) on the course of CVS is not yet finally clarified. Thus we aimed to identify risk factors of recurrent CVS and vasospasm-related infarction following TBA.

Material und Methoden We analyzed 35 patients with CVS after sSAH who received TBA (41 procedures, 99 vessels). Demographic and clinical data, localization of the aneurysm, the initial treatment modality, functional outcome after 3 months and in-hospital mortality were obtained. TBA was analyzed concerning time point, localization, technique, complications and angiographic response. Furthermore, recurrence of CVS and vasospasm-related infarction after TBA were described and risk factors were identified with logistic regression analyses.

Ergebnisse In 7 of 35 patients (20%) and in 16 of 99 vessels (16%) previously treated with TBA, we found recurrent CVS. Vasospasm-related infarction occurred in 18 cases (18%) in the arterial territories of the TBA-treated vessels. The angiographic effect after TBA was mostly classified as good (87%), good response was negatively associated with recurrent CVS (p=0.004) and vasospasm-related infarction (p=0.001). We identified only the male gender as a risk factor for vasospasm-related infarction after TBA (p=0.040). In connection with TBA, only one complication occurred (intracranial dissection).

Schlußfolgerungen Our data support TBA as a safe and effective therapy for CVS. Nevertheless, recurrent CVS and vasospasm-related infarction are present in a significant proportion in spite of TBA. We describe for the first time an elevated risk for vasospasm-related infarction in male patients after TBA. Our results augment the still sparse evidence concerning optimal patient selection for this method and provide new aspects for individual therapy decisions.