E-039 Clinical characteristics of traumatic brain injury patients undergoing endovascular rescue for post-traumatic vasospasm

Abstract

Background Cerebral vasospasm is a serious sequela of traumatic brain injury (TBI) which leads to further neurologic injury subsequent to the initial trauma. The natural history, associated risk factors, and the optimal treatment strategy is not well understood. We aim to evaluate the clinical and radiographic characteristics of patients with TBI who underwent endovascular rescue therapy for post-traumatic vasospasm (PTV). Methods This is a descriptive case series of all patients with TBI who underwent endovascular rescue therapy for PTV between October 2017 to November 2019. We studied the clinical characteristics - age, sex, Glascow coma scale (GCS), need for craniotomy or craniectomy, radiographic characteristics on the CT scan on the day of presentation, presence of subarachnoid hemorrhage (SAH), location of SAH, presence of contusion, presence of SDH, and presence of pseudoaneurysm of the patients who underwent rescue therapy. The timing of occurrence of vasospasm, severity of spasm on angiography, type of rescue therapy and dose of medication used were also studied. We evaluated association of these clinical characteristics with cumulative severity of vasospasm observed on angiography. Descriptive statistics were used for analysis. Results We identified 22 patients with PTV with 69 rescue angiograms performed (mean: 3.2; range: 1–9 angiograms per patient) during this period. Average age upon presentation was 40-years old, 81% of the patients were male sex and average GCS was 6.8. Sixty-seven percent of the patients underwent craniotomy or craniectomy. All patients had SAH, though only 60% had cisternal SAH. Parenchymal contusion was noted on 90% as well as SDH in 90%. The PTV were noted between 3 to 19 days after trauma. All patients undergoing rescue therapy received verapamil infusion (5–35 mg). There was no correlation (r2 >0.5) between any of the clinical or radiographic variables studied and cumulative or average severity noted on the angiograms for each patient. Conclusion Post-traumatic vasospasm can be detected as early as post trauma day 3 to 19 in patients with TBI and SAH. Absence of cisternal SAH does not rule out occurrence of the vasospasm during the course of treatment. Disclosures K. Khatibi: None. L. Ponce Mejia: None. H. Saber: None. N. Kenoko: None. R. Jahan: None. S. Tateshima: None. M. Nour: None. G. Colby: None. G. Duckwiler: None. V. Szeder: None.