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High Risk of New Episode of Symptomatic Vasospasm in Unaffected Arteries in Subarachnoid Hemorrhage Patients Receiving Targeted Endovascular Treatment for Symptomatic Focal Vasospasm

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Abstract

Background

There is controversy whether asymptomatic vasospasm in other arteries should be concurrently treated (global treatment) in patients receiving targeted endovascular treatment [percutaneous-transluminal-angioplasty (PTA) and/or intra-arterial (IA) vasodilators] for focal symptomatic vasospasm.

Objective

To determine the rates of occurrence of new symptomatic vasospasm in previously asymptomatic arterial distributions among patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent targeted endovascular treatment for focal symptomatic vasospasm.

Methods

We identified all patients with SAH who had received targeted endovascular treatment during a 4-year period. We ascertained any new occurrence of symptomatic vasosopasm requiring endovascular treatment in previously unaffected (and untreated) arterial distributions within the same hospitalization. Blinded reviewers quantitatively graded angiographic vasospasm (<25, 26–49, ≥50 %) in all major arteries for each patient at the time of targeted treatment.

Results

Of the 41 patients who received targeted endovascular treatment (PTA in 41 % and vasodilators in 59 %), 11 (27 %) developed new symptomatic vasospasm in previously asymptomatic vascular distributions requiring endovascular treatment. Moderate severity of angiographic vasospasm in asymptomatic arteries at the time of targeted treatment tended to predict the occurrence of new symptomatic vasospasm. The rate of death and disability at discharge [modified Rankin scale (mRS) of 3–6] was 82 % (9/11) among those who developed a new episode of symptomatic vasospasm compared with 70 % (21/30) in those who did not (P = 0.58).

Conclusions

High risk of new occurrence of ischemic symptoms in previously asymptomatic (and untreated) arterial distributions among patients receiving targeted treatment should be recognized. Further studies should evaluate the benefit of performing global endovascular treatment during the initial targeted endovascular treatment session.

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Acknowledgments

Dr. Qureshi has received funding from the National Institute of Health RO1-NS44976-01A2 (medication provided by ESP Parma), American Heart Association Established Investigator Award (0840053N), National Institute of Health U01-NS062091-01A2, and the Minnesota Medical Foundation, Minneapolis, MN.

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Authors and Affiliations

  1. Zeenat Qureshi Stroke Research Center and Department of Neurology, University of Minnesota, 420 Delaware St. SE. MMC 295, Minneapolis, MN, 55455, USA

    Wondwossen G. Tekle, Saqib A. Chaudry, Ameer E. Hassan, Habib Qaiser, Mikayel Grigoryan, Gustavo J. Rodriguez & Adnan I. Qureshi

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  1. Wondwossen G. Tekle
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  2. Saqib A. Chaudry
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  3. Ameer E. Hassan
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  4. Habib Qaiser
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  5. Mikayel Grigoryan
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  6. Gustavo J. Rodriguez
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  7. Adnan I. Qureshi
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Correspondence to Wondwossen G. Tekle.

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Tekle, W.G., Chaudry, S.A., Hassan, A.E. et al. High Risk of New Episode of Symptomatic Vasospasm in Unaffected Arteries in Subarachnoid Hemorrhage Patients Receiving Targeted Endovascular Treatment for Symptomatic Focal Vasospasm. Neurocrit Care 20, 399–405 (2014). https://doi.org/10.1007/s12028-013-9825-2

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  • DOI: https://doi.org/10.1007/s12028-013-9825-2

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