Ditz Claudia, Neumann Alexander, Wojak Jann, Smith Emma, Gliemroth Jan, Tronnier Volker, Küchler Jan
Department of Neurosurgery, University of Lübeck, Lübeck, Germany.
Department of Neuroradiology, University of Lübeck, Lübeck, Germany.
World Neurosurg. 2018 Apr;112:e791-e798. doi: 10.1016/j.wneu.2018.01.156. Epub 2018 Feb 1.
Endovascular interventions in patients with subarachnoid hemorrhage (SAH) and symptomatic cerebral vasospasm (sCVS) are commonly performed, but the potential benefits of repeated interventions have not been proven. The aim of this study was to show the potential burden and opportunities of repeated endovascular interventions in cases of recurrent sCVS.
We reviewed 15 patients with SAH who underwent more than 2 endovascular treatments of recurrent sCVS (CVS group) regarding the radiation doses, their clinical course, and their functional outcome. A case-control group of SAH patients without sCVS individually matched for age, World Federation of Neurosurgical Societies score, Fisher grade, and treatment modality was used as control group (non-CVS group).
A total of 70 endovascular treatments were performed in the CVS group. CVS group patients received longer mechanical ventilation (585 days vs. 439 days) and showed a higher rate of tracheostomy (12/15 vs. 7/15) and shunt-dependent hydrocephalus (6/15 vs. 2/15) than did the non-CVS patients. Moreover, patients from the CVS group underwent significantly (P < 0.001) more angiographies (median, 5 vs. 2) and CTP/CTA scans (median, 4 vs. 1) and consequently received significantly (P < 0.001) higher radiation doses. The rate of unfavorable outcomes (mRS 3-6) after 3 months was nonsignificantly higher in the CVS group (6/15 vs. 2/15), but after 6 months at least 5/14 patients from the CVS group showed a favorable outcome.
Repeated endovascular treatments of SAH patients with recurrent CVS are complex and expose the patients to high radiation doses. Nevertheless, favorable results could be achieved in patients in otherwise poor condition.
蛛网膜下腔出血（SAH）合并症状性脑血管痉挛（sCVS）患者常进行血管内介入治疗，但重复干预的潜在益处尚未得到证实。本研究的目的是展示复发性sCVS病例中重复血管内介入治疗的潜在负担和机会。
我们回顾了15例接受了2次以上复发性sCVS血管内治疗的SAH患者（CVS组）的辐射剂量、临床病程和功能结局。将一组年龄、世界神经外科协会联合会评分、Fisher分级和治疗方式相匹配的无sCVS的SAH患者作为对照组（非CVS组）。
CVS组共进行了70次血管内治疗。与非CVS组患者相比，CVS组患者机械通气时间更长（585天对439天），气管切开率更高（12/15对7/15），分流依赖性脑积水发生率更高（6/15对2/15）。此外，CVS组患者接受的血管造影（中位数，5次对2次）和CTP/CTA扫描（中位数，4次对1次）显著更多（P < 0.001），因此接受的辐射剂量显著更高（P < 0.001）。3个月后不良结局（改良Rankin量表评分3 - 6分）的发生率在CVS组略高（6/15对2/15），但无统计学意义，而6个月后CVS组至少5/14的患者有良好结局。
SAH合并复发性CVS患者的重复血管内治疗较为复杂，且使患者暴露于高辐射剂量下。然而，在其他情况较差的患者中仍可取得良好结果。
