Institution of sustained endovascular treatment prior to clinical deterioration in patients with severe angiographic vasospasm: A retrospective observational study of clinico-radiological outcomes - 03/06/15
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Summary |
Severe angiographic vasospasm (aVSP) is a risk factor for infarction following subarachnoid haemorrhage and infarction is strongly associated with poor outcome. We present the clinico-radiological results of cohort with severe aVSP who underwent a program of angiographic surveillance and sustained endovascular treatment using multiple verapamil infusions and/or transluminal balloon angioplasty (TBA).
Methods |
This was a dual-centre retrospective observational study. Angiographic screening for vasospasm was undertaken at days 5–7 post-ictus. Treatment was instituted principally on the basis of radiographic findings. The rate of infarction was evaluated on follow-up CT. Clinical outcome was assessed using the modified Rankin Scale (mRS).
Results |
Fifty-seven WFNS grades 1–5 patients were studied. The mean number of procedures/patient was 6, range 2–13. Mean verapamil dose administered to the ICA was 14mg and VA was 12mg. Thirty-one patients underwent TBA (52.6%). The rate of proximal vessel infarction was 3/45 (6.7%) for patients presenting <72hours. Rates of favourable outcome (mRS 0–2) were 16/19 (84.2%) for WFNS grades 1–2, 12/19 (63.2%) for grades 3–4 and 5/19 (26.3%) for grade 5 patients. Delayed presentation >72hours was the only factor on multivariate analysis to significantly predict aVSP-infarction [OR19.3 (3.2–116.6) P=0.0012]. Large aVSP-infarction [OR19.0 (1.7–216.4) 0.0179] and poor WFNS grade [OR 6.6 (1.3–33.9) P=0.0233] were significant predictors of poor outcome on multivariate analysis.
Conclusion |
This approach may result in low rates of aVSP-infarction and encouraging rates of favourable outcome when compared to literature benchmarks. Delayed presentation, however, predicts infarction and large infarct and poor initial grade significantly influence functional outcome.
Le texte complet de cet article est disponible en PDF.Keywords : Subarachnoid hemorrhage, Vasospasm, Infarction, Stroke, Endovascular, Angioplasty, Delayed ischaemia, DIND, Verapamil
Abbreviations : aVSP, WFNS, SAH, GCS, DSA, TBA, CT, TCD, CBF, IA, VA, BA, ICA, MCA, ACA, PCA, OR, CI, GOS, mRS
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Vol 42 - N° 3
P. 176-183 - juin 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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