Rao Aliana, Ricci Samuel, Hannah Theodore, Graves Erin, Quach Eric, Erkmen Kadir, Almefty Rami
Temple University, Philadelphia, PA, USA.
Temple University Hospital, Philadelphia, PA, USA.
Neuroradiology. 2025 Jul 28. doi: 10.1007/s00234-025-03713-y.
Cerebral vasospasm (CV) is a common complication following aneurysmal subarachnoid hemorrhage (aSAH) that contributes to significant morbidity and mortality. While numerous identified CV risk factors exist, illicit substance use's influence, particularly cocaine, remains controversial. This study aims to elucidate relationships between known risk factors and CV's incidence, severity, and refractoriness.
A retrospective chart review was conducted on all aSAH patients between 2014 and 2023 with inclusion criteria of confirmed aneurysms on digital subtraction angiography (DSA) and available urine drug screens (UDS). Demographic data, Hunt-Hess (HH), modified Fisher Scale (mFS), comorbidities, and vasospasm grades were collected. Outcomes, including vasospasm treatment counts, length of stay (LOS), and 3-month modified Rankin Scale (mRS) scores, were recorded.
Of 88 patients, 43% experienced CV. Cocaine use was significantly more prevalent in the CV group (26% vs. 8%, p = 0.04) and increased CV risk (OR = 4.11, 95% CI: 1.25-16.13, p = 0.03), independent of other factors. Higher HH grades were associated with increased CV incidence (OR = 1.75, p = 0.01), severity (β = 0.271, p = 0.02), and 3-month mRS scores (β = 0.81, p < 0.001). Female sex also predicted vasospasm incidence (OR = 4.78, p = 0.01). Older age was associated with worse long-term outcomes (β = 0.05, p = 0.004). In the multivariable analysis, cocaine revealed a significant increased risk of CV incidence (OR = 5.79, p = 0.02). Higher HH grades significantly impacted CV severity (OR = 0.30, p = 0.01) and worse long-term outcomes (OR = 0.957, p < 0.01) in the multivariable analysis.
Females, those with positive cocaine use on UDS, and a history of T2DM were at an increased risk of CV with no impact on severity, recurrence, or 3-month outcomes. Older age was associated with worse long-term outcomes. HH grade was significantly associated with increased vasospasm severity, refractoriness to treatment, and worse long-term outcomes as per mRS scores.
脑血管痉挛（CV）是动脉瘤性蛛网膜下腔出血（aSAH）后的常见并发症，会导致显著的发病率和死亡率。虽然已确定了许多CV风险因素，但非法药物使用的影响，尤其是可卡因，仍存在争议。本研究旨在阐明已知风险因素与CV的发生率、严重程度和难治性之间的关系。
对2014年至2023年间所有aSAH患者进行回顾性病历审查，纳入标准为数字减影血管造影（DSA）证实有动脉瘤且有可用的尿液药物筛查（UDS）。收集人口统计学数据、Hunt-Hess（HH）分级、改良Fisher量表（mFS）、合并症和血管痉挛分级。记录结果，包括血管痉挛治疗次数、住院时间（LOS）和3个月改良Rankin量表（mRS）评分。
88例患者中，43%发生了CV。可卡因使用在CV组中显著更常见（26%对8%，p = 0.04），且增加了CV风险（OR = 4.11，95%CI：1.25 - 16.13，p = 0.03），独立于其他因素。较高的HH分级与CV发生率增加（OR = 1.75，p = 0.01）、严重程度增加（β = 0.271，p = 0.02）和3个月mRS评分增加（β = 0.81，p < 0.001）相关。女性也预示着血管痉挛的发生率（OR = 4.78，p = 0.01）。年龄较大与较差的长期结果相关（β = 0.05，p = 0.004）。在多变量分析中，可卡因显示CV发生率风险显著增加（OR = 5.79，p = 0.02）。在多变量分析中，较高的HH分级显著影响CV严重程度（OR = 0.30，p = 0.01）和较差的长期结果（OR = 0.957，p < 0.01）。
女性、UDS上可卡因使用呈阳性者以及有2型糖尿病病史者发生CV的风险增加，对严重程度、复发率或3个月结果无影响。年龄较大与较差的长期结果相关。HH分级与血管痉挛严重程度增加、治疗难治性以及根据mRS评分得出的较差长期结果显著相关。
