Departments of1Neurosurgery.
2Neurology, and.
J Neurosurg. 2023 Apr 28;139(5):1302-1310. doi: 10.3171/2023.3.JNS222720. Print 2023 Nov 1.
Cerebral arterial vasospasm is a dreaded sequela of aneurysm rupture and can result in significant narrowing of the surrounding vasculature and subsequent cerebral ischemia. Treatment interventions are associated with distinct side effect profiles, including the risk of thrombosis and worsened ischemia, which may be associated with increased mortality-especially in older adults. An improved understanding of the likelihood of vasospasm in elderly patients would enable clinicians and patients to better consider the risks and benefits of vasospasm prophylaxis in this vulnerable population. This retrospective chart review aimed to assess the relationship between age at onset and the incidence of cerebral vasospasm among patients treated at the University of North Carolina Medical Center with spontaneous aneurysmal subarachnoid hemorrhage (aSAH).
Electronic health record data from the Epic Systems Corp. database, compiled by the Carolina Data Warehouse for Health, were analyzed for patients older than 18 years who were previously treated for an SAH secondary to aneurysm at the University of North Carolina Medical Center within the past 10 years, ranging from June 2011 through June 2021. Logistic regression was used to calculate odds ratios and to determine the association of age with the occurrence of vasospasm following aSAH.
Of the 386 cases analyzed, 149 patients (38.6%) were older than 65 years at the time of aSAH. A total of 192 of the 386 patients (49.7%) developed vasospasm within the first 3-21 days following aSAH. Among the patients who developed vasospasm, only 31 of 192 patients (16.1%) were older than 65 years at the time of aneurysm rupture. Odds ratio calculations revealed that older adults (> 65 years) were 8 times less likely to develop vasospasm compared to their younger counterparts (p < 0.0001; 95% CI 5.0-13.0).
This study found that older patients are less likely to develop cerebral vasospasm following aSAH than are younger individuals. Age-associated changes in arteriosclerosis, inflammatory responses, and CSF dynamics may mitigate vascular narrowing in response to aSAH. This finding suggests that the aSAH treatment and vasospasm prevention paradigms should be revised to minimize potentially unnecessary interventions and avoid adverse outcomes for older adults.
颅内动脉血管痉挛是动脉瘤破裂的一种可怕后遗症，可导致周围血管显著狭窄和随后的脑缺血。治疗干预措施具有明显不同的副作用谱，包括血栓形成和缺血恶化的风险，这可能与死亡率增加有关——尤其是在老年人中。对老年人发生血管痉挛的可能性有更深入的了解，将使临床医生和患者能够更好地考虑在这一脆弱人群中预防血管痉挛的风险和益处。这项回顾性图表研究旨在评估北卡罗来纳大学医学中心治疗的自发性蛛网膜下腔出血 (aSAH) 患者发病年龄与脑血管痉挛发生率之间的关系。
从 Epic Systems Corp. 数据库的电子健康记录数据（由北卡罗来纳州卫生数据仓库编制）中分析了过去 10 年内在北卡罗来纳大学医学中心因动脉瘤治疗过 aSAH 的年龄大于 18 岁的患者。采用 logistic 回归计算比值比，并确定年龄与 aSAH 后发生血管痉挛的相关性。
在分析的 386 例病例中，有 149 例（38.6%）在发生 aSAH 时年龄大于 65 岁。在 aSAH 后 3-21 天内，386 例患者中有 192 例（49.7%）发生血管痉挛。在发生血管痉挛的患者中，只有 192 例患者中的 31 例（16.1%）在动脉瘤破裂时年龄大于 65 岁。比值比计算显示，与年轻患者相比，老年患者（>65 岁）发生血管痉挛的可能性低 8 倍（p<0.0001；95%CI 5.0-13.0）。
本研究发现，与年轻患者相比，老年患者发生 aSAH 后发生脑血管痉挛的可能性较低。动脉粥样硬化、炎症反应和 CSF 动力学的年龄相关变化可能减轻对 aSAH 的血管狭窄反应。这一发现表明，aSAH 治疗和血管痉挛预防方案应进行修订，以尽量减少潜在的不必要干预，并避免老年人的不良后果。
