Abstract
Background
Cerebral vasospasm (cVSP) is a common complication in aneurysmal subarachnoid hemorrhage
(aSAH) and is associated with worse outcomes. However, clinical significance of asymptomatic
cVSP is poorly understood. We sought to determine the association of asymptomatic
cVSP with functional outcome and hospital length of stay (LOS).
Methods
We performed a retrospective study of a prospectively collected cohort of patients
with aSAH who survived hospitalization at an academic center between 2016 and 2021.
We defined cVSP based on transcranial Doppler criteria. Multivariate logistic and
multiple linear regression analyses were used to determine the association of asymptomatic
cVSP with poor functional outcome (defined as modified Rankin scale 3-6 at 3 months
after discharge) and hospital length of stay (LOS).
Results
The cohort consisted of 201 aSAH patients with a mean age 54.9 years (SD 13.6) and
60% were female. One hundred nine patients (54%) experienced cVSP, of whom 43 patients
(39%) were asymptomatic. Patients with asymptomatic cVSP were younger (mean 50.5 years
[SD 10.6] vs 61 years [SD12.5]; p < 0.001) and had longer ICU LOS (median 13 days [IQR12-20] vs median 12 days [IQR9-15],
p = 0.018) compared to those without cVSP. However, after adjusting with other variables
asymptomatic cVSP was not associated with longer ICU or hospital LOS. Asymptomatic
cVSP was not associated with poor outcome either (p = 0.14).
Conclusion
Asymptomatic cVSP, which was more common in younger patients, was neither associated
with poor functional outcome nor hospital LOS. Larger prospective studies are needed
to assess the significance of asymptomatic cVSP on long-term outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A review of the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.World Neurosurg. 2019; 126: 513-527
- An overview of pharmacotherapy for cerebral vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage.Expert Opin Pharmacother. 2021; 22: 1601-1614
- Is asymptomatic vasospasm associated with poor outcome in subarachnoid hemorrhage?.Neurohospitalist. 2011; 1: 165-171
- Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?.Stroke. 2009; 40: 1963-1968
- Pathophysiology of delayed cerebral ischemia after subarachnoid hemorrhage: a review.J Am Heart Assoc. 2021; 10e021845
- How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage.Curr Opin Crit Care. 2021; 27: 103-114
- Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association.Stroke. 2012; 43: 1711-1737
- Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the neurocritical care society's multidisciplinary consensus conference.Neurocrit Care. 2011; 15: 211-240
- Cerebral vasospasm.Neurosurg Clin N Am. 2014; 25: 497-528
- Costs of vasospasm in patients with aneurysmal subarachnoid hemorrhage.Neurosurgery. 2010; 67 (discussion 351-342): 345-351
- Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.J Neurosurg. 2016; 124: 1257-1264
- Surgical risk as related to time of intervention in the repair of intracranial aneurysms.J Neurosurg. 1968; 28: 14-20
- Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale.Neurosurgery. 2006; 59 (discussion 21-27): 21-27
- The REDCap consortium: building an international community of software platform partners.J Biomed Inform. 2019; 95103208
- The role of transcranial Doppler ultrasonography in the diagnosis and management of vasospasm after aneurysmal subarachnoid hemorrhage.Neurosurg Clin N Am. 2010; 21: 291-303
- Transcranial doppler ultrasonography: from methodology to major clinical applications.World J Cardiol. 2016; 8: 383-400
- Transcranial-Doppler-measured vasospasm severity is associated with delayed cerebral infarction after subarachnoid hemorrhage.Neurocrit Care. 2021;
- Vasospasm and delayed cerebral ischaemia in patients with spontaneous subarachnoid haemorrhage (aneurysmal and pretruncal non-aneurysmal): a centre's perspective.Med J Malaysia. 2021; 76: 17-23
- Circulatory volume expansion therapy for aneurysmal subarachnoid haemorrhage.Cochrane Database Syst Rev. 2004; CD000483
- Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?.Neurosurg Focus. 2006; 21: E1
- Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial.Stroke. 2000; 31: 383-391
- Systematic review of the prevention of delayed ischemic neurological deficits with hypertension, hypervolemia, and hemodilution therapy following subarachnoid hemorrhage.J Neurosurg. 2003; 98: 978-984
- Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study.Neurosurgery. 2001; 49 (discussion 605-596): 593-605
Article Info
Publication History
Published online: October 12, 2022
Accepted:
October 3,
2022
Received in revised form:
September 20,
2022
Received:
August 17,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106821
Copyright
© 2022 Elsevier Inc. All rights reserved.
