Introduction: Vasospasm is the major cause of delayed morbidity and mortality in patients who survive aneurysmal subarachnoid hemorrhage (aSAH). Although many studies have shown decreased rates of vasospasm in patients who underwent endovascular procedures compared to open microsurgery (“clipping”), the association between surgical modality and vasospasm is a current debate in the field. Rates of vasospasm in patients with aSAH at Jefferson Hospital for Neuroscience (JHN) from 2011-2014 were analyzed and compared with surgical modality and other data points.
Methods: We conducted a retrospective study of patients treated for aSAH at JHN. Vasospasm was defined via angiography.
Results: 233 patients fit the study criteria with 46 patients who underwent endovascular procedures and 187 underwent open microsurgery. There were no significant differences between these two groups in demographics or presentation. Although the rate of symptomatic vasospasm for patients who underwent coiling was lower than clipped patients (12.4% v. 17.8%), this was not statistically significant (p=0.33). In comparison of patients with vasospasm (n = 31) and patients without vasospasm (n=202), there was a lower concentration of magnesium in patients with vasospasm versus patients without vasospasm (1.5 v. 1.6 mg/dL, p = 0.017). There were no significant differences in patients with or without vasospasm in: blood pressure, lipid profile, age, Hunt-Hess grade, smoking status, BMI, or calcium.
Conclusions: Although there was not statistically significant relationship between rates of vasospasm and surgical modality, there was a trend of decreased vasospasm in the endovascular group, which agrees with previous recent reports . The difference in magnesium agrees with the concept of using magnesium sulfate to treat vasospasm, however this has yet to be proved effective in human patients. This study demonstrates that there is no conclusive link between surgical modality and vasospasm in patients suffering from aSAH.
Patient Care: This research adds to the growing literature on the comparison of endovascular vs. open microsurgery for aSAH which will ultimately improve patient outcome.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of vasospasm in aSAH. 2) Discuss, in small groups, the pros and cons of endovascular vs. open microsurgery for aSAH.
References: 1) Gross, B. A., Rosalind Lai, P. M., Frerichs, K. U. & Du, R. Treatment Modality and Vasospasm After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. (2013).