Abstract TP419: Worse Outcome After Intraoperative Re-Rupture In Subarachnoid Hemorrhage Not Due to Increased Vasospasm

Abstract

INTRODUCTION: Intraoperative re-rupture of cerebral aneurysms is a frequent complication of subarachnoid hemorrhage (SAH) treatment. Studies have demonstrated worsened outcomes after re-rupture, particularly in those treated with surgical clipping, for reasons that are unknown. We designed a study to test the hypothesis that worsened outcomes in these patients may be due to increased vasospasm. Detecting a higher incidence of vasospasm in this population would justify aggressive early treatment to prevent subsequent ischemic injury in those with intraoperative re-rupture after SAH. METHODS: All patients with aneurysmal SAH treated with open surgical clipping between 2006-2008 were examined at a single institution. Angiographic vasospasm was defined as narrowing of vessels seen on catheter angiography. Symptomatic vasospasm was defined as clinical deterioration after other causes had been excluded or radiographic evidence of infarction attributable to vasospasm. RESULTS: We identified 241 consecutive patients that included 41 with intraoperative re-rupture (17%). Average age was 54 ± 13 years and 69% of the patients were female. Hunt Hess scores between the group with intraoperative re-rupture and without were similar (2.1 ±1.3 vs. 2.4 ± 1.3, p = 0.09). Modified Fischer scores were also similar between the two groups (2.8 ±1.2 vs. 2.8 ± 1.2, p = 0.66). Time from rupture to definitive treatment was not significantly different (3.5 days ± 3.2 vs. 3.5 days ± 3.2, p=0.9). Patients in both groups had similar histories of smoking (58% vs. 50%, p=0.47) and HTN (49% vs. 53%, p=0.72). Angiographic vasospasm was seen in 61% of the group without re-rupture and 63% in the group with re-rupture (p=0.83). Symptomatic vasospasm was seen in 38% of patients without re-rupture and 49% of patients with re-rupture (p=0.26). In-hospital mortality was higher in the group with intraoperative re-rupture (20% vs. 9%, p<0.05). DISCUSSION: Our results corroborated previous findings of worsened outcomes after intraoperative re-rupture in SAH patients treated with surgical clipping, but did not show a significant difference in rates of vasospasm. These findings indicate that the worsened outcome of these patients is likely secondary to other, as yet known, causes.