Outcome Following Symptomatic Cerebral Vasospasm on Presentation in Aneurysmal Subarachnoid Hemorrhage: Coiling vs. Clipping

Abstract

Cerebral vasospasm complicates both surgical and endovascular treatment of ruptured aneurysms. The present study analyzes patients with presentation vasospasm (PVSP) treated in the acute setting and compares outcomes in those treated with surgical clipping versus endovascular coiling. Data from 600 aneurysmal subarachnoid hemorrhage (aSAH) patients who were admitted to the University of Illinois Medical Center in Chicago between June 2002 and July 2007 were retrospectively reviewed. Patients with clinical vasospasm on presentation were compared with patients who developed delayed vasospasm during hospitalization. Subgroup analysis compared outcomes in patients with vasospasm on presentation treated with surgical clipping versus endovascular coiling. Of the 600 aSAH patients, 30 (5%) patients presented with symptomatic vasospasm (PVSP) confirmed by cerebral angiography and 179 (30%) patients were diagnosed with symptomatic vasospasm following admission (delayed vasospasm after admission [DVSP]). Patients admitted with vasospasm showed longer latency to admission after the rupture (5.5 vs. 1.5 day, P ≤ 0.001) but comparable latency to onset of symptomatic vasospasm after rupture. There was no significant difference between the two groups with respect to unfavorable outcome (modified Rankin Scale score > 3), death, or stroke. Therefore, aneurysm treatment during the vasospasm period did not result in increased morbidity in those patients. Within the subgroup of patients presenting with vasospasm on admission, there was no significant difference in outcome between patients who were treated with clipping versus coiling. Outcome did not differ between aSAH patients treated in the presence of symptomatic vasospasm compared to those with subsequent vasospasm. The outcome of patients presenting with vasospasm was not influenced by the modality of aneurysm treatment. This suggests that both surgical and endovascular intervention for the treatment of ruptured aneurysms are equally valid options in the setting of existing symptomatic vasospasm.