Abstract P555: Safety and Efficacy of Daily Intra-Arterial Endovascular Therapy for Medically Refractory Cerebral Vasospasm Following Subarachnoid Hemorrhage

Abstract

Introduction: Delayed cerebral ischemia (DCI) and cerebral infarction due to medically refractory vasospasm in aneurysmal SAH (aSAH) is a major cause of death and disability. The guidelines for endovascular therapy (EVT) for medically refractory vasospasm are not well established, especially regarding duration and frequency of therapy. Methods: Single center retrospective chart review was performed. We included patients with aSAH who had medically refractory vasospasm and underwent EVT. Demographics, clinical characteristics, imaging data, procedural details and outcomes were collected. Results: From 2016 to 2019, 303 subarachnoid hemorrhage (SAH) patients were identified. 133 (43.9%) were aSAH, of which 120 (90.2%) had DCI. Forty-one (34.1%) patients met our inclusion criteria. Median age was 56 years [Interquartile range (IQR) 46, 63] and 33 (80.5%) patients were female. We divided the EVT arm into two groups, group 1 underwent < 3 consecutive days of EVT comprising of 11 patients (26.8%) and group 2 underwent ≥3 consecutive days of EVT comprising of 30 patients (73.2%). Median Hunt and Hess score and Fisher grade were 1.5 (IQR 1,3) and 3.5 (IQR 2,4)in group 1 and 3 (IQR 2,4) and 4 (3,4) in group 2, (p =0.08) and (p =0.5) respectively . Median number of days of EVT was 4(IQR 2,6.5) for the entire cohort. Median days of EVT in group 1 was 2 (IQR 1,2) and for group 2 was 5 (IQR 3,7, p=0.24). Cerebral infarction was seen in 5/11 (45.4%) patients in group 1 and 16/30 (53.3%) patients in group 2 (p = 0.73). Median modified Rankin scale (mRS) at discharge in both groups was 4 (p=0.55, r=0.1). Good clinical outcome at discharge (mRS 0-2) was seen in 4/11 (36.3%) patients in group 1 and 5/30 (16.7%) patients in group 2 (p=0.22). Procedure related complications were seen in 3/11 (27.2%) patients in group 1 and 3/30 (10%) patients in group 2 (p=0.32) whereas mortality rate was 1/11(9.1%) and 8/30 (26.6%) (p=0.4)respectively. No mortality was associated with the procedure. Conclusion: Daily endovascular therapy in medically refractory vasospasm is safe but not efficacious in reducing the rates of cerebral infarctions.