Outcome of aneurismal subarachnoid hemorrhage: How far is vasospasm involved? – Retrospective study

AbstractPurposeTo evaluate vasospasm and/or other possible mechanisms as a contributor to poor outcome following aneurismal subarachnoid hemorrhage (SAH).Materials and methodsSixty patients with aneurismal SAH, and severe cerebral vasospasm warranting endovascular angioplasty were included. Data included age, sex, bleeding severity, number and territory of spastic arteries, angioplasty result, development of new infarcts and their location relative to spastic territory. Final outcome was reported.ResultsThere was strong correlation between outcome and both grade of hemorrhage and age. Angioplasty was either successful (80%), equivocal (10%), failed (8.3%), or could not be done (1.7%).New Infarcts were found in 44/60 patients (73.3%). In 7 of which (16%) they were out of spastic territory. The remaining 37 (84.1%) had infarcts anatomically related to spasm, of these, 28 had successful angioplasty (75%).No new infarcts were found in the remaining 16 patients (26.7%). There was no significant correlation between new infarcts and either successful angioplasty or outcome. However, when outcome was correlated to infarcts within the spastic territory, it turned strongly significant (p=0.008).ConclusionVasospasm and new infarcts have different pathophysiology. Only the coexistence of both in the same territory significantly correlates with poor outcome. Both are related to severity of SAH