Dominance of the Anterior Cerebral Artery as a Predictor of Vasospasm-Related Cerebral Infarction After Surgical Treatment of Ruptured Blood Blister-Like Aneurysm in the Internal Carotid Artery

Abstract

Vasospasm (VSP)-related ischemic complications have been associated with poor outcomes in patients with subarachnoid hemorrhage due to ruptured blood blister-like aneurysms (BBAs) in the communicating segment of the internal carotid artery (ICA). The purpose of the present study was to investigate the incidence of, and factors related to, VSP-related cerebral infarction (VSP-CI) in patients with surgically treated BBAs in the communicating segment of the ICA. The medical records of 25 consecutive patients with surgically treated BBAs in the communicating segment of the ICA were reviewed. The preoperative angiographic findings, surgical methods, and patient outcomes, including VSP-CI, were evaluated. Of the 25 patients, 10 had undergone extracranial-intracranial (EC-IC) bypass with trapping and 15 had undergone clipping surgery. VSP-CI occurred in the ipsilateral hemisphere to the aneurysm in 4 patients with EC-IC bypass with trapping and in 6 patients who had undergone received clipping. Positive balloon test occlusion findings did not affect the occurrence of VSP-CI in the EC-IC bypass and trapping group. The occurrence of VSP-CI was significantly greater in the patients with a dominant anterior cerebral artery ipsilateral to the aneurysm on the preoperative angiogram (P= 0.023), with a hazard ratio of 14.14 (95% confidence interval, 1.57-127.68). The results of preoperative balloon test occlusion were less reliable for predicting postoperative ischemic complications of EC-IC bypass with trapping in patients with ruptured BBAs in the communicating segment of the ICA. However, anterior cerebral artery dominance ipsilateral to the ruptured aneurysm could be predictive for postoperative VSP-CI.