Prognostic Value and Determinants of Ultraearly Angiographic Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Prognostic Value and Determinants of Ultraearly Angiographic Vasospasm after Aneurysmal... AbstractOBJECTIVEA small number of patients with aneurymal subarachnoid hemorrhage have angiographic evidence of cerebral vasospasm within 48 hours of the onset of hemorrhage. The present study analyzes the prognostic value and determinants of this ultraearly angiographic finding.METHODSWe analyzed prospectively collected data from the placebo-treated group in a multicenter clinical trail conducted at 54 neurosurgical centers in North America. The presence and severity of ultraearly angiographic vasospasm (UEAV) was determined by ablinded review of the admission angiograms. Using logistic regresssion analysis, we identified independent determinants of UEAV from demographic,clinical, laboratory, and neuro-imaging characteristics of the patients. The impact of UEAV on the risk of symptomatic vasospasm and 3-month outcome was analyzed after adjusting for potential confounding factors.RESULTSOf 296 patients in the analysis, 37 (13%) had angiographic evidence of vasospasm at admission. An initial Glasgow Coma Scale score of less than 14 (odds ratio [OR], 2.5; 95% confidence interval [Cl], 1.1-6.0), and serum sodium greater than 138 mmol/L (OR, 3.4; 95% Cl, 1.5-8.3) were associated with UEAV. UEAV was associated with increased risk of symptomatic vasospasm (OR, 2.5; 95% Cl, 1.2-5.4) and poor outcome at 3 months (OR, 2.8; 95% Cl, 1.2-6.3), after adjusting for other variables. This risk of symptomatic vasospasm was not influenced by early surgery (within 48 h of hemorrhage onset). Poor outcome was more likely to occur in patients with UEAV who did not undergo early surgery (P = 0.03).CONCLUSIONOur analysis suggests that patients with angiographic evidence of vasospasm at admission are at high risk for both symptomatic vasospasm and poor outcome. We also found that early surgery did not aggravate this risk. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Prognostic Value and Determinants of Ultraearly Angiographic Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Prognostic Value and Determinants of Ultraearly Angiographic Vasospasm after Aneurysmal Subarachnoid Hemorrhage

P r o g n o s t i c V a l u e a n d D e t e r m i n a n t s o f U l t r a e a r l y A n g i o g r a p h i c V a s o s p a s m a f t e r A n e u r y s m a l S u b a r a c h n o i d H e m o r r h a g e A d n a n I . Q u r e s h i , M . D . , G e n e Y . S u n g , M . D . , M . A s a d K . S u r i , M . D . , R o b e r t N . S t r a w , P h . D . , L e e R . G u t e r m a n , P h . D . , M . D . , L . N e l s o n H o p k i n s , M . D . , a n d P a r t i c i p a n t s Department of Neurosurgery (A IQ , LR G , LN H ), U niversity at Buffalo, Buffalo, N ew Yo rk; Department of Neurology (G YS), U niversity of Colorado, Denver, C olo rad o; John Peters Hospital (MAKS), Fort W orth, Texas; and D ivisio n of C N S/C ritical Care (RNS), Pharmacia & U pjohn, Kalam azoo, Michigan conducted a , 5 4 n e u r o s u r g ,c a l c e n te r s a n g io g r a l U s in g lo g is tic re g re s s io n vasospasm ( U E A V ) w a s d e t e r m i n e d b y a b y frQ m d e m o g r a p h j c , c lin ic a l, l a b o r a t o r y , a n d n e u r o - analysis, w e i d e n t i f i e d l n d e P e " ^ ' d e ' ^ e i m p a c t o f U E A V o n t h e risk o f s y m p t o m a t i c vaso sp asm a n d 3 - m o n t h imagine c h a r a c t e r i s t i c s o f t h e p a tie n ts , i ne p „ j ; nn f , r t n « outcom e w as a n a l y z e d a f t e r a d ju s t in g f o r p o t e n m c o " ° “ h k e v id e n c e o f v as o s p a s m a t a d m is s io n . A n i n it i a l RESULTS: O f 2 9 6 p a tie n ts in t h e a n a ly s is , 3 7 ( 1 3 ^ ) h a d a g g p c o n f id e n C e in t e r v a l [ C l ] , 1 . 1 - 6 . 0 ) , a n d Glasgow C o m a S c a le s c o r e o f less t h a " , \ 4 ^ d ^ V a^ 0 2 ° cR IL 3 ) w e r e a s s o c ia te d w i t h U E A V . U E A V w a s serum s o d iu m g r e a t e r t h a n 1 3 8 m m o l / L { , ■ r 1 . 2 - 5 . 4 ) a n d p o o r o u t c o m e a t associated w i t h in c r e a s e d ris k o f o t h e r v a r ia b le s . T h is ris...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199905000-00017
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEA small number of patients with aneurymal subarachnoid hemorrhage have angiographic evidence of cerebral vasospasm within 48 hours of the onset of hemorrhage. The present study analyzes the prognostic value and determinants of this ultraearly angiographic finding.METHODSWe analyzed prospectively collected data from the placebo-treated group in a multicenter clinical trail conducted at 54 neurosurgical centers in North America. The presence and severity of ultraearly angiographic vasospasm (UEAV) was determined by ablinded review of the admission angiograms. Using logistic regresssion analysis, we identified independent determinants of UEAV from demographic,clinical, laboratory, and neuro-imaging characteristics of the patients. The impact of UEAV on the risk of symptomatic vasospasm and 3-month outcome was analyzed after adjusting for potential confounding factors.RESULTSOf 296 patients in the analysis, 37 (13%) had angiographic evidence of vasospasm at admission. An initial Glasgow Coma Scale score of less than 14 (odds ratio [OR], 2.5; 95% confidence interval [Cl], 1.1-6.0), and serum sodium greater than 138 mmol/L (OR, 3.4; 95% Cl, 1.5-8.3) were associated with UEAV. UEAV was associated with increased risk of symptomatic vasospasm (OR, 2.5; 95% Cl, 1.2-5.4) and poor outcome at 3 months (OR, 2.8; 95% Cl, 1.2-6.3), after adjusting for other variables. This risk of symptomatic vasospasm was not influenced by early surgery (within 48 h of hemorrhage onset). Poor outcome was more likely to occur in patients with UEAV who did not undergo early surgery (P = 0.03).CONCLUSIONOur analysis suggests that patients with angiographic evidence of vasospasm at admission are at high risk for both symptomatic vasospasm and poor outcome. We also found that early surgery did not aggravate this risk.

Journal

NeurosurgeryOxford University Press

Published: May 1, 1999

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