Clinical predictors of delayed cerebral ischemia after subarachnoid hemorrhage: first experience with coil embolization in the management of ruptured cerebral aneurysms.

OBJECTIVE

The purpose of this study was to clarify the clinical predictors of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH).

METHODS

102 patients with ruptured cerebral aneurysms were treated (77 by clipping and 25 by coiling). 40 patients were male and 62 were female. Median age was 59 years (range 31-88). The modified Rankin Scale was used to assess functional outcomes 3 months after treatment or at discharge. The associations between potential clinical risk factors and DCI after SAH were assessed using the χ(2) test.

RESULTS

52 patients (51.0%) had a good outcome and 13 patients (12.7%) died despite treatment. DCI was observed in 26 patients and hydrocephalus was observed in 37 patients. There were marginal differences in clinical outcomes between the treatment groups (p=0.053), mainly because functional outcomes were significantly superior in the coiling group (p=0.04) in patients with severe SAH. DCI was seen less frequently in the coiling group than in the clipping group (4.0% vs 32.4%, p=0.001). The presence of hydrocephalus was significantly associated with the occurrence of DCI (p<0.001). Multivariate logistic regression analysis also showed that the treatment modality and the presence of hydrocephalus were independent risk factors for DCI.

CONCLUSION

DCI was less frequently observed in the coiling group, and clinical outcomes were also superior in the coiling group, especially for patients with severe SAH. The results showed a significant correlation between DCI and hydrocephalus.