Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
J Neurointerv Surg. 2022 Apr;14(4):376-379. doi: 10.1136/neurintsurg-2021-017424. Epub 2021 Jun 2.
Patients with aneurysmal subarachnoid hemorrhage (aSAH) frequently suffer from vasospasm. We analyzed the association between absence of early angiographic vasospasm and early discharge.
All aSAH patients treated from August 1, 2007, to July 31, 2019, at a single tertiary center were reviewed. Patients undergoing diagnostic digital subtraction angiography (DSA) on post-aSAH days 5 to 7 were analyzed; cohorts with and without angiographic vasospasm (angiographic reports by attending neurovascular surgeons) were compared. Primary outcome was hospital length of stay; secondary outcomes were intensive care unit length of stay, 30 day return to the emergency department (ED), and poor neurologic outcome, defined as a modified Rankin Scale (mRS) score >2.
A total of 298 patients underwent DSA on post-aSAH day 5, 6, or 7. Most patients (n=188, 63%) had angiographic vasospasm; 110 patients (37%) did not. Patients without vasospasm had a significantly lower mean length of hospital stay than vasospasm patients (18.0±7.1 days vs 22.4±8.6 days; p<0.001). The two cohorts did not differ significantly in the proportion of patients with mRS scores >2 at last follow-up or those returning to the ED before 30 days. After adjustment for Hunt and Hess scores, Fisher grade, admission Glasgow Coma Scale score, and age, logistic regression analysis showed that the absence of vasospasm on post-aSAH days 5-7 predicted discharge on or before hospital day 14 (OR 3.4, 95% CI 1.8 to 6.4, p<0.001).
Lack of angiographic vasospasm 5 to 7 days after aSAH is associated with shorter hospitalization, with no increase in 30 day ED visits or poor neurologic outcome.
患有颅内动脉瘤性蛛网膜下腔出血（aSAH）的患者经常患有血管痉挛。我们分析了早期血管造影无血管痉挛与早期出院之间的关系。
回顾 2007 年 8 月 1 日至 2019 年 7 月 31 日期间在一家三级中心治疗的所有 aSAH 患者。对在 aSAH 后第 5 至 7 天进行诊断性数字减影血管造影（DSA）的患者进行分析；比较有和无血管造影血管痉挛（主治神经血管外科医生的血管造影报告）的队列。主要结果是住院时间；次要结果是重症监护病房住院时间、30 天内返回急诊室（ED）和不良神经结局，定义为改良 Rankin 量表（mRS）评分>2。
共有 298 例患者在 aSAH 后第 5、6 或 7 天进行 DSA。大多数患者（n=188，63%）有血管造影血管痉挛；110 例（37%）没有。无血管痉挛患者的平均住院时间明显短于有血管痉挛患者（18.0±7.1 天 vs 22.4±8.6 天；p<0.001）。两组在最后随访时 mRS 评分>2 的患者比例或在 30 天内返回 ED 的患者比例无显著差异。在校正 Hunt 和 Hess 评分、Fisher 分级、入院格拉斯哥昏迷量表评分和年龄后，逻辑回归分析显示，aSAH 后 5-7 天无血管痉挛预测 14 天内出院（OR 3.4，95%CI 1.8 至 6.4，p<0.001）。
aSAH 后 5-7 天无血管造影血管痉挛与住院时间缩短相关，30 天内 ED 就诊或不良神经结局无增加。
