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Does the method of treatment of acutely ruptured intracranial aneurysms influence the incidence and duration of cerebral vasospasm and clinical outcome?
  1. A J P Goddard1,2,
  2. P P J Raju1,
  3. A Gholkar1
  1. 1Neurosciences Department, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne, NE4 6BE, UK
  2. 2MRI Department, Imaging Centre, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
  1. Correspondence to:
 Dr A Goddard
 MRI Department, Imaging Centre, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK; Tony.Goddardmail.qmc.uh-tr.trent.nhs.uk

Abstract

Objectives: Cerebral vasospasm remains the leading cause of death and permanent disability after subarachnoid haemorrhage. This study determined whether the method of aneurysm treatment plays an important role in determining the incidence of cerebral vasospasm and its clinical consequences.

Methods: Admission data, cranial computed tomography (CT), treatment details, transcranial Doppler (TCD) results, and clinical outcomes of patients who had surgical or endovascular management of their ruptured aneurysm were recorded and subject to multivariate analysis.

Results: Between January 1995 and December 1999, 292 eligible patients (206 female, 86 male) had definitive aneurysm treatment at our unit. 212 patients were clipped, 80 coiled. There was no significant difference in patient age, pre-treatment neurological grade, Fisher grade, or timing of treatment in the two groups. 48.3% patients developed TCD detected cerebral vasospasm and 16.1% patients developed permanent ischaemic neurological deficit. At clinical follow up, 84.2% of patients were well (mGOS 1 and 2) with a cumulative death rate of 6.5% from all causes.

The only significant predictor of TCD-detected cerebral vasospasm was patient age (inversely, p = 0.004). Increased patient age, vasospasm, poor pre-treatment WFNS, and higher CT Fisher grades correlated with a poor discharge GOS. However, only poor pre-treatment WFNS grade and patient age correlated with poor GOS at follow up (p<0.001).

Conclusion: The treatment method had no influence on the incidence or duration of TCD detected vasospasm and there was no significant difference in outcome at discharge or follow up between those patients who had surgery or endovascular management of their aneurysms.

  • cerebral vasospasm
  • transcranial Doppler
  • endovascular treatment
  • CSF, cerebrospinal fluid
  • CT, computed tomography
  • GDC, Guglieimi Detachable colis
  • ISAT, International Subarachnoid Aneurysm Trial
  • mGOS, modified Glasgow Outcome Score
  • SAH, subarachnoid haemorrhage
  • TCD, transcranial Doppler

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Footnotes

  • Competing interests: none declared