Cargando…

Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage

BACKGROUND: Aneurysm treatment during cerebral vasospasm (CVS) phase is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct. OBJECTIVE: We aimed to evaluate the risk of aneurysmal subarachnoid haemorrhage (aSAH)-specific complications and functional outcom...

Descripción completa

Detalles Bibliográficos
Autores principales: Hostettler, Isabel C., Kreiser, Kornelia, Lange, Nicole, Schwendinger, Nina, Trost, Dominik, Frangoulis, Samira, Hirle, Theresa, Gempt, Jens, Wostrack, Maria, Meyer, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9468043/
https://www.ncbi.nlm.nih.gov/pubmed/35729347
http://dx.doi.org/10.1007/s00415-022-11212-w
_version_ 1784788324964106240
author Hostettler, Isabel C.
Kreiser, Kornelia
Lange, Nicole
Schwendinger, Nina
Trost, Dominik
Frangoulis, Samira
Hirle, Theresa
Gempt, Jens
Wostrack, Maria
Meyer, Bernhard
author_facet Hostettler, Isabel C.
Kreiser, Kornelia
Lange, Nicole
Schwendinger, Nina
Trost, Dominik
Frangoulis, Samira
Hirle, Theresa
Gempt, Jens
Wostrack, Maria
Meyer, Bernhard
author_sort Hostettler, Isabel C.
collection PubMed
description BACKGROUND: Aneurysm treatment during cerebral vasospasm (CVS) phase is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct. OBJECTIVE: We aimed to evaluate the risk of aneurysmal subarachnoid haemorrhage (aSAH)-specific complications and functional outcome in patients treated during CVS phase. METHODS: We retrospectively analysed a large, retro- and prospectively collected database of aSAH patients admitted to our department between March 2006 and March 2020. We conducted a uni- and multivariable logistic regression analysis to evaluate influencing factors on rebleeding, cerebral infarct, Glasgow Outcome Score (GOS) at discharge and mortality and assessed the rate of angiographic vasospasm on admission. RESULTS: We included 853 patients. The majority of patients were female (66.6%), mean age was 57.3 years. Out of 853 included patients, 92 (10.8%) were treated during CVS phase, 312 (36.6%) underwent clipping and 541 (63.4%) endovascular treatment. Treatment during CVS phase was significantly associated with cerebral infarct in the multivariable logistic regression analysis, unrelated to the nature of intervention (OR 2.42, 1.29–4.54 95% CI p-value = 0.006). However, patients treated during CVS phase did not have increased risk of unfavourable outcome by GOS on discharge. In addition, they did not have a higher rate of rebleeding or mortality. CONCLUSIONS: Treatment during CVS phase was significantly associated with a higher rate of cerebral infarct as confirmed by imaging. This did not reflect on GOS on discharge, rebleeding, or mortality. Aneurysm treatment during CVS phase is relatively safe and should not be postponed due to the risk of rebleeding and subsequent devastating deterioration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-022-11212-w.
format Online
Article
Text
id pubmed-9468043
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-94680432022-09-14 Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage Hostettler, Isabel C. Kreiser, Kornelia Lange, Nicole Schwendinger, Nina Trost, Dominik Frangoulis, Samira Hirle, Theresa Gempt, Jens Wostrack, Maria Meyer, Bernhard J Neurol Original Communication BACKGROUND: Aneurysm treatment during cerebral vasospasm (CVS) phase is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct. OBJECTIVE: We aimed to evaluate the risk of aneurysmal subarachnoid haemorrhage (aSAH)-specific complications and functional outcome in patients treated during CVS phase. METHODS: We retrospectively analysed a large, retro- and prospectively collected database of aSAH patients admitted to our department between March 2006 and March 2020. We conducted a uni- and multivariable logistic regression analysis to evaluate influencing factors on rebleeding, cerebral infarct, Glasgow Outcome Score (GOS) at discharge and mortality and assessed the rate of angiographic vasospasm on admission. RESULTS: We included 853 patients. The majority of patients were female (66.6%), mean age was 57.3 years. Out of 853 included patients, 92 (10.8%) were treated during CVS phase, 312 (36.6%) underwent clipping and 541 (63.4%) endovascular treatment. Treatment during CVS phase was significantly associated with cerebral infarct in the multivariable logistic regression analysis, unrelated to the nature of intervention (OR 2.42, 1.29–4.54 95% CI p-value = 0.006). However, patients treated during CVS phase did not have increased risk of unfavourable outcome by GOS on discharge. In addition, they did not have a higher rate of rebleeding or mortality. CONCLUSIONS: Treatment during CVS phase was significantly associated with a higher rate of cerebral infarct as confirmed by imaging. This did not reflect on GOS on discharge, rebleeding, or mortality. Aneurysm treatment during CVS phase is relatively safe and should not be postponed due to the risk of rebleeding and subsequent devastating deterioration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-022-11212-w. Springer Berlin Heidelberg 2022-06-22 2022 /pmc/articles/PMC9468043/ /pubmed/35729347 http://dx.doi.org/10.1007/s00415-022-11212-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Communication
Hostettler, Isabel C.
Kreiser, Kornelia
Lange, Nicole
Schwendinger, Nina
Trost, Dominik
Frangoulis, Samira
Hirle, Theresa
Gempt, Jens
Wostrack, Maria
Meyer, Bernhard
Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage
title Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage
title_full Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage
title_fullStr Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage
title_full_unstemmed Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage
title_short Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage
title_sort treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9468043/
https://www.ncbi.nlm.nih.gov/pubmed/35729347
http://dx.doi.org/10.1007/s00415-022-11212-w
work_keys_str_mv AT hostettlerisabelc treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT kreiserkornelia treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT langenicole treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT schwendingernina treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT trostdominik treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT frangoulissamira treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT hirletheresa treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT gemptjens treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT wostrackmaria treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage
AT meyerbernhard treatmentduringcerebralvasospasmphasecomplicationassociationandoutcomeinaneurysmalsubarachnoidhaemorrhage