Behzadi Faraz, Tsiang John T, Jani Ronak H, Payman Andre A, Bond Brandon J, Kam Anthony W, Pasquale David D, Serrone Joseph C
Department of Neurological Surgery, Loyola University Medical Center, United States.
Department of Neurological Surgery, Loyola University Medical Center, United States.
Clin Neurol Neurosurg. 2025 Jul;254:108927. doi: 10.1016/j.clineuro.2025.108927. Epub 2025 Apr 28.
Post-hemorrhagic cerebral vasospasm (PHCV) in aneurysmal subarachnoid hemorrhage (aSAH) often requires endovascular intervention with either intra-arterial (IA) vasodilator therapy or percutaneous transluminal balloon angioplasty (PTA). This study aimed to evaluate the angiographic efficacy of endovascular treatments with clinical outcomes.
We retrospectively reviewed patients (≥18 years) who underwent IA vasodilator therapy or PTA for PHCV following aSAH at our institution from 2007 to 2023. Patients were stratified into "good" and "poor" outcome cohorts based on a 6-month modified Rankin Scale > 2. Identifiable risk factors were assessed using univariate and multivariate analyses. We compared angiographic changes in vessel diameter, cerebral circulation time (CCT), and retreatment rates between (1) PTA plus IA vasodilator sessions vs. IA-only sessions, and (2) verapamil-only vs. verapamil plus another agent. The statistically significant variables were used to create a scoring model to predict poor outcome.
Eighty-three patients (mean age 52 years, 66 % female) with 246 treated vessels met inclusion criteria. IA vasodilators alone were used in 220 vessels, and PTA plus IA vasodilators were used in 26 vessels. 65 % of patients had a poor 6-month outcome. Male sex (p = 0.016), Black race (p = 0.030), hypertension (p = 0.015), earlier vasospasm onset (p = 0.016), and longer initial pre-treatment CCT (p = 0.033) were independently associated with poor outcomes. Vasospasm symptom of headaches alone (p = 0.044) was protective. PTA plus IA vasodilators more effectively increased the M1 diameter than IA vasodilators alone but CCT reductions were the same. Improvement in angiographic parameters was not associated with improved clinical outcome. Verapamil-only had the same angiographic and clinical outcomes compared to Verapamil plus another agent. The scoring model used 6-variables with an AUC = 0.746 to predict clinical outcomes.
In this single-center retrospective study of PHCV, despite angiographic improvements with endovascular therapy, there was no associated improvement in clinical outcomes.
动脉瘤性蛛网膜下腔出血（aSAH）后的出血后脑血管痉挛（PHCV）通常需要进行血管内介入治疗，即动脉内（IA）血管扩张剂治疗或经皮腔内球囊血管成形术（PTA）。本研究旨在评估血管内治疗的血管造影疗效及临床结局。
我们回顾性分析了2007年至2023年在我院因aSAH后PHCV接受IA血管扩张剂治疗或PTA的患者（≥18岁）。根据6个月改良Rankin量表评分>2将患者分为“良好”和“不良”结局队列。使用单因素和多因素分析评估可识别的危险因素。我们比较了（1）PTA联合IA血管扩张剂治疗与单纯IA治疗之间，以及（2）单纯维拉帕米治疗与维拉帕米联合另一种药物治疗之间血管直径、脑循环时间（CCT）的血管造影变化以及再次治疗率。使用具有统计学意义的变量创建一个评分模型来预测不良结局。
83例患者（平均年龄52岁，66%为女性）共246条血管接受治疗，符合纳入标准。220条血管仅使用了IA血管扩张剂，26条血管使用了PTA联合IA血管扩张剂。65%的患者6个月结局不良。男性（p = 0.016）、黑人种族（p = 0.030）、高血压（p = 0.015）、血管痉挛发作较早（p = 0.016）以及初始治疗前CCT较长（p = 0.033）与不良结局独立相关。仅头痛的血管痉挛症状（p = 0.044）具有保护作用。PTA联合IA血管扩张剂比单纯IA血管扩张剂更有效地增加了M1段直径，但CCT的降低程度相同。血管造影参数的改善与临床结局的改善无关。单纯维拉帕米治疗与维拉帕米联合另一种药物治疗的血管造影和临床结局相同。该评分模型使用6个变量，AUC = 0.746来预测临床结局。
在这项关于PHCV的单中心回顾性研究中，尽管血管内治疗在血管造影方面有所改善，但临床结局并未随之改善。
