Does endovascular treatment of cerebral vasospasm improve short term clinical outcome? Single centre experience

Cerebral vasospasm after subarachnoid haemorrhage (SAH) is a major complication causing cerebral ischemia and infarction. Mainly it is common from 4th to 14th day after SAH and neurological deficit severity depends on early treatment. Study included 529 patients hospitalized in Riga East University Hospital from January 2013 to June 2019 with diagnosis acute non-traumatic subarachnoid haemorrhage. From medical histories patients with clinical and radiological signs of cerebral vasospasm was identified, clinical outcomes were evaluated. Clinically significant cerebral vasospasm was identified as complication in 87 (16,44%) patients after non-traumatic subarachnoid haemorrhage with predominance in aneurysm rupture group 21,47% vs non-specific SAH group without angiographic finding - 2,72%. There were 47 females with cerebral vasospasm with mean age 59,24 years (38-87), male patients 40 with mean age 50,15 years (22 – 90). Most of the patients in 70,96% were hospitalized with GKS 10 to 15 and Fisher scale 4 in 67 cases (72,04%). Mortality after cerebral vasospasm was determined in 34,48% (30 patients). There were 46 patients of cerebral vasospasm treated by endovascular approach and 41 patients with conservative treatment. Clinical results were estimated by patient’s independence, using modified Rankin scale. In the group of endovascularly treated cerebral vasospasm mRS score 0 -2 were estimated in 22 patients (54,34%), in group of vasospasm conservative treatment - 3 patients (7,31%). Moderate to severe disability with mRS scale 3-5 in first group was detected in 14 cases (30,43%), in second group - 14 patients (34,14%). mRS 6 in the first group was in 7 cases (15,21%), in the group with conservative treatment - 24 cases (58,53%). Clinically significant cerebral vasospasm has higher rate of mortality comparing to general population of subarachnoid haemorrhage patients. Endovascular treatment of cerebral vasospasm is linked to higher rate of patients’ independence and lower mortality.