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Cerebral Vasospasm: Neurovascular Events After Subarachnoid Hemorrhage pp 33–40Cite as

Angiographic Vasospasm Versus Cerebral Infarction as Outcome Measures After Aneurysmal Subarachnoid Hemorrhage

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 115))

Abstract

Background and purpose: Despite a significant reduction of angiographic vasospasm, the reduction of poor functional outcome in clinical trials on aneurysmal subarachnoid hemorrhage (SAH) remains challenging. While there is general consensus that vasospasm is associated with delayed cerebral ischemia (DCI), cerebral infarction, poor functional outcome, and mortality after SAH, causal relationships are subject to discussion. Therefore, it was the aim of our study to investigate the relationship between various outcome measures and poor functional outcome in clinical trials on pharmaceutical treatment of SAH.

Methods: Based on data from two systematic reviews and a post hoc exploratory analysis, the relationship between the following outcome measures was investigated: (1) radiographic vasospasm, (2) DCI, (3) cerebral infarction, (4) poor functional outcome, and (5) death.

Results: A reduction of angiographic vasospasm did not correlate with an improvement on dichotomous Glasgow Outcome Scale/modified Rankin Scale (GOS/mRS). In contrast, a reduction of cerebral infarction correlated with better neurological outcomes. The heterogeneous definition of DCI in previous clinical trials did not allow pooling of the data. Conclusion: Future clinical trials may use cerebral infarction and functional outcome as main outcome measures to ­investigate the true impact of an intervention, assuming that the intervention targets cerebral infarction and hereby improves outcome.

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Disclosures and Acknowledgements

R.L. Macdonald received grant support from the Physicians Services Incorporated Foundation and the Heart and Stroke Foundation of Ontario. R.L. Macdonald is a consultant for Actelion Pharmaceuticals and chief scientific officer of Edge Therapeutics, Incorporated.

Conflicts of Interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Heinrich-Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany

    Nima Etminan

  2. Department of Neurology and Neurosurgery, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Mervyn D. I. Vergouwen M.D., Ph.D.

  3. Division of Neurosurgery, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8, ON, Canada

    R. Loch Macdonald

  4. Department of Surgery, University of Toronto, Toronto, ON, Canada

    R. Loch Macdonald

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  1. Nima Etminan
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  2. Mervyn D. I. Vergouwen M.D., Ph.D.
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  3. R. Loch Macdonald
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Correspondence to Nima Etminan .

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Editors and Affiliations

  1. , Department of Neurosurgery, University of Cincinnati, Stetson, Suite 2200 260, Cincinnati, 45267-0515, Ohio, USA

    Mario Zuccarello

  2. College of Medicine, Department of Neurology, University of Cincinnati, Albert Sabin Way 231MSB room 1, Cincinnati, 46267-0536, Ohio, USA

    Joseph F. Clark

  3. College of Medicine, Dept. of Neurology and Neurosurgery, University of Cincinnati, Albert Sabin Way 231ML0517, Cincinnati, 45267-0517, Ohio, USA

    Gail Pyne-Geithman

  4. College of Medicine, Dept. of Neurosurgery, University of Cincinnati, Stetson St. Suite 260ML0515, Cincinnati, 45219, Ohio, USA

    Norberto Andaluz

  5. College of Medicine, Dept. of Neurosurgery, University of Cincinnati, Stetson, Suite 2200 260, Cincinnati, 45219, Ohio, USA

    Jed A. Hartings

  6. , Dept. of Emergency Medicine, University of Cincinnati, Albert Sabin Way 231ML0769, Cincinnati, 45267-0769, Ohio, USA

    Opeolu M. Adeoye

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Etminan, N., Vergouwen, M.D.I., Macdonald, R.L. (2013). Angiographic Vasospasm Versus Cerebral Infarction as Outcome Measures After Aneurysmal Subarachnoid Hemorrhage. In: Zuccarello, M., Clark, J., Pyne-Geithman, G., Andaluz, N., Hartings, J., Adeoye, O. (eds) Cerebral Vasospasm: Neurovascular Events After Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 115. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1192-5_8

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  • DOI: https://doi.org/10.1007/978-3-7091-1192-5_8

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