Introduction: The pro-thrombotic milieu seen in subarachnoid hemorrhage (SAH) poses a unique challenge to neurovascular surgeons with regard to device use and microcatheter practice. Our objective is to determine how demographic factors and balloon practices impact diffusion-weighted imaging (DWI) abnormalities and outcomes in patients with subarachnoid hemorrhage (SAH) compared to those without (non-SAH).
Methods: We retrospectively analyzed 77 patients with SAH treated by balloon-assisted coiling in a single institution compared with 81 consecutive patients with unruptured aneurysms treated by balloon-assisted coiling at the same institution. Data was collected with regard to demographic factors, procedural and anatomic considerations, and DWI abnormalities on postprocedural MRI.
Results: SAH patients were significantly more likely to have DWI abnormality (75% vs. 21%, p<0.0001) and had higher number and volume of DWI (4.0 vs. 3.0, p=0.0421 and 1.3 vs. 0.3 cc, p=0.0041) despite similar balloon practices. SAH patients were not more likely to have DWI abnormality in vascular territory distal to the treated aneurysm, but had higher likelihood of DWI in a vascular territory unrelated to the aneurysm (81.5% vs. 47.1%, p=0.0235). Patients without DWI abnormality were significantly more likely to have a good outcome as defined by mRS 0-2 (95.6% vs. 81.6%, p=0.0328). Patients with DWI abnormality more often underwent 4-vessel angiography (70.5% vs. 48.0%, p=0.0174).
Conclusions: Balloon-assisted coiling does not result in increased incidence of downstream ischemic events in SAH patients compared to non-SAH patients and is safe in this cohort of patients. Other factors, such as 4-vessel angiography of the SAH milieu itself may predispose patients to a higher rate of ischemic events.
Patient Care: This study will improve patient care by providing further evidence to support safety of the technique of balloon-assisted coiling in the setting of subarachnoid hemorrhage. Additionally, it will help to identify risk factors for the development of ischemic events following cerebral angiography in this patient population, which will help to improve outcomes, as our data suggests higher rates of ischemic events following angiography result in lower functional status.
Learning Objectives: After reading, the audience should be able to describe differences in diffusion-weighted imaging (DWI) abnormalities between patients undergoing balloon-assisted coiling of intracranial aneurym in patients with subarachnoid hemorrhage as compared to those without subarachnoid hemorrhage. Additionally, the audience should be able to discuss how procedural factors such as 4-vessel angiography and balloon practices, as well as patient characteristics, affect rates of DWI in these populations.