367 Functional Outcome in Patients with Refractory Cerebral Vasospasm Treated with Repeat Instant Endovascular Interventions

Abstract

Abstract INTRODUCTION For patients suffering from cerebral vasospasm refractory to medical and hemodynamic therapies, endovascular interventions often remain the last resort. Data from studies in large cohorts on the efficacy and safety of multiple immediate endovascular interventions are sparse. Our aim was to assess the functional outcome of multiple repeated instant endovascular interventions in patients with cerebral vasospasm refractory to medical, hemodynamic, and initial endovascular interventions. METHODS A single-center retrospective study of prospectively collected data on patients suffering from cerebral vasospasm refractory to therapies requiring at least 3 endovascular interventions during the course of treatment following aneurysmal subarachnoid hemorrhage. The primary endpoint was functional outcome at last follow-up (mRS <3). The secondary endpoint was angiographic response to endovascular therapies and appearance of cerebral infarctions. RESULTS >Over a 4-year period, 365 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Thirty-one (8.5%) met the inclusion criteria. In 52 (14%) patients, <3 endovascular interventions were performed as rescue therapy for refractory cerebral vasospasm. At last follow-up, a good outcome was noted in 18 (58%) patients with 3 or more interventions compared to 31 (61%) of those with 1 or 2 interventions (P = 0.82). The initial Hunt and Hess score <3 was a significant independent predictor of good outcome (OR 4.7, 95% CI, 1.2 18.5; P = 0.03), whereas infarcts in eloquent brain areas were significantly associated with a poor outcome (mRS 3 6; OR 13.5, 95% CI, 2.3 81.2; P = 0.004). CONCLUSION Repeated instant endovascular intervention is an aggressive but feasible last resort treatment strategy with a favorable outcome in two-thirds of patients with refractory cerebral vasospasm and in whom endovascular treatment has already been initiated.