Predictors of outcome after endovascular treatment of cerebral vasospasm

Alejandro Rabinstein, Jonathan A. Friedman, Douglas A. Nichols, Mark A. Pichelmann, Robyn L. McClelland, Edward M. Manno, John L D Atkinson, Eelco F M Wijdicks

Research output: Contribution to journalReview article

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Abstract

BACKGROUND AND PURPOSE: Angioplasty and intra-arterial papaverine are promising treatments for severe symptomatic vasospasm after subarachnoid hemorrhage (SAII), but there is little information on the clinical factors that predict treatment outcome. We sought to determine variables for predicting functional outcome in this setting. METHODS: We reviewed 81 consecutive patients with symptomatic cerebral vasospasm from aneurysmal SAH treated with percutaneous balloon angioplasty or selective intra-arterial papaverine infusion between 1990 and 2000 (105 procedures). Logistic regression analysis was used to assess the effect of various clinical and angiographic factors on outcome. RESULTS: Mean patient age was 54 years (range, 29-88 years). Twenty-nine patients (36%) presented with poor-grade (World Federation of Neurologic Surgeons [WFNS] grade IV or V) SAH. Clinical deficits were global in 55 patients (70%), and angiographic vasospasm was diffuse in 53 (65%). Endovascular treatment consisted of transluminal angioplasty alone (18 procedures, 17%), intra-arterial papaverine infusion (65 procedures, 62%), or both (22 procedures, 21%). Unequivocal arterial dilatation was achieved in all but two patients, and major complications occurred in 2% of the procedures. Ten patients (12%) died in the hospital, and 36 (44%) recovered poorly. Permanent deficits attributable to cerebral vasospasm were present in 37 patients (52% of survivors). On multivariate logistic regression analysis, advanced age and poor WFNS grade at presentation were predictive of poor clinical outcome. CONCLUSION: Advanced age and poor clinical status at the time of SAH onset are predictive of poor clinical outcome despite endovascular treatment with angioplasty or intra-arterial papaverine in patients with symptomatic vasospasm.

Original languageEnglish (US)
Pages (from-to)1778-1782
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume25
Issue number10
StatePublished - Nov 2004

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Intracranial Vasospasm
Papaverine
Angioplasty
Intra Arterial Infusions
Therapeutics
Nervous System
Logistic Models
Regression Analysis
Balloon Angioplasty
Subarachnoid Hemorrhage
Survivors
Dilatation

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Rabinstein, A., Friedman, J. A., Nichols, D. A., Pichelmann, M. A., McClelland, R. L., Manno, E. M., ... Wijdicks, E. F. M. (2004). Predictors of outcome after endovascular treatment of cerebral vasospasm. American Journal of Neuroradiology, 25(10), 1778-1782.

Predictors of outcome after endovascular treatment of cerebral vasospasm. / Rabinstein, Alejandro; Friedman, Jonathan A.; Nichols, Douglas A.; Pichelmann, Mark A.; McClelland, Robyn L.; Manno, Edward M.; Atkinson, John L D; Wijdicks, Eelco F M.

In: American Journal of Neuroradiology, Vol. 25, No. 10, 11.2004, p. 1778-1782.

Research output: Contribution to journalReview article

Rabinstein, A, Friedman, JA, Nichols, DA, Pichelmann, MA, McClelland, RL, Manno, EM, Atkinson, JLD & Wijdicks, EFM 2004, 'Predictors of outcome after endovascular treatment of cerebral vasospasm', American Journal of Neuroradiology, vol. 25, no. 10, pp. 1778-1782.
Rabinstein A, Friedman JA, Nichols DA, Pichelmann MA, McClelland RL, Manno EM et al. Predictors of outcome after endovascular treatment of cerebral vasospasm. American Journal of Neuroradiology. 2004 Nov;25(10):1778-1782.
Rabinstein, Alejandro ; Friedman, Jonathan A. ; Nichols, Douglas A. ; Pichelmann, Mark A. ; McClelland, Robyn L. ; Manno, Edward M. ; Atkinson, John L D ; Wijdicks, Eelco F M. / Predictors of outcome after endovascular treatment of cerebral vasospasm. In: American Journal of Neuroradiology. 2004 ; Vol. 25, No. 10. pp. 1778-1782.
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abstract = "BACKGROUND AND PURPOSE: Angioplasty and intra-arterial papaverine are promising treatments for severe symptomatic vasospasm after subarachnoid hemorrhage (SAII), but there is little information on the clinical factors that predict treatment outcome. We sought to determine variables for predicting functional outcome in this setting. METHODS: We reviewed 81 consecutive patients with symptomatic cerebral vasospasm from aneurysmal SAH treated with percutaneous balloon angioplasty or selective intra-arterial papaverine infusion between 1990 and 2000 (105 procedures). Logistic regression analysis was used to assess the effect of various clinical and angiographic factors on outcome. RESULTS: Mean patient age was 54 years (range, 29-88 years). Twenty-nine patients (36{\%}) presented with poor-grade (World Federation of Neurologic Surgeons [WFNS] grade IV or V) SAH. Clinical deficits were global in 55 patients (70{\%}), and angiographic vasospasm was diffuse in 53 (65{\%}). Endovascular treatment consisted of transluminal angioplasty alone (18 procedures, 17{\%}), intra-arterial papaverine infusion (65 procedures, 62{\%}), or both (22 procedures, 21{\%}). Unequivocal arterial dilatation was achieved in all but two patients, and major complications occurred in 2{\%} of the procedures. Ten patients (12{\%}) died in the hospital, and 36 (44{\%}) recovered poorly. Permanent deficits attributable to cerebral vasospasm were present in 37 patients (52{\%} of survivors). On multivariate logistic regression analysis, advanced age and poor WFNS grade at presentation were predictive of poor clinical outcome. CONCLUSION: Advanced age and poor clinical status at the time of SAH onset are predictive of poor clinical outcome despite endovascular treatment with angioplasty or intra-arterial papaverine in patients with symptomatic vasospasm.",
author = "Alejandro Rabinstein and Friedman, {Jonathan A.} and Nichols, {Douglas A.} and Pichelmann, {Mark A.} and McClelland, {Robyn L.} and Manno, {Edward M.} and Atkinson, {John L D} and Wijdicks, {Eelco F M}",
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T1 - Predictors of outcome after endovascular treatment of cerebral vasospasm

AU - Rabinstein, Alejandro

AU - Friedman, Jonathan A.

AU - Nichols, Douglas A.

AU - Pichelmann, Mark A.

AU - McClelland, Robyn L.

AU - Manno, Edward M.

AU - Atkinson, John L D

AU - Wijdicks, Eelco F M

PY - 2004/11

Y1 - 2004/11

N2 - BACKGROUND AND PURPOSE: Angioplasty and intra-arterial papaverine are promising treatments for severe symptomatic vasospasm after subarachnoid hemorrhage (SAII), but there is little information on the clinical factors that predict treatment outcome. We sought to determine variables for predicting functional outcome in this setting. METHODS: We reviewed 81 consecutive patients with symptomatic cerebral vasospasm from aneurysmal SAH treated with percutaneous balloon angioplasty or selective intra-arterial papaverine infusion between 1990 and 2000 (105 procedures). Logistic regression analysis was used to assess the effect of various clinical and angiographic factors on outcome. RESULTS: Mean patient age was 54 years (range, 29-88 years). Twenty-nine patients (36%) presented with poor-grade (World Federation of Neurologic Surgeons [WFNS] grade IV or V) SAH. Clinical deficits were global in 55 patients (70%), and angiographic vasospasm was diffuse in 53 (65%). Endovascular treatment consisted of transluminal angioplasty alone (18 procedures, 17%), intra-arterial papaverine infusion (65 procedures, 62%), or both (22 procedures, 21%). Unequivocal arterial dilatation was achieved in all but two patients, and major complications occurred in 2% of the procedures. Ten patients (12%) died in the hospital, and 36 (44%) recovered poorly. Permanent deficits attributable to cerebral vasospasm were present in 37 patients (52% of survivors). On multivariate logistic regression analysis, advanced age and poor WFNS grade at presentation were predictive of poor clinical outcome. CONCLUSION: Advanced age and poor clinical status at the time of SAH onset are predictive of poor clinical outcome despite endovascular treatment with angioplasty or intra-arterial papaverine in patients with symptomatic vasospasm.

AB - BACKGROUND AND PURPOSE: Angioplasty and intra-arterial papaverine are promising treatments for severe symptomatic vasospasm after subarachnoid hemorrhage (SAII), but there is little information on the clinical factors that predict treatment outcome. We sought to determine variables for predicting functional outcome in this setting. METHODS: We reviewed 81 consecutive patients with symptomatic cerebral vasospasm from aneurysmal SAH treated with percutaneous balloon angioplasty or selective intra-arterial papaverine infusion between 1990 and 2000 (105 procedures). Logistic regression analysis was used to assess the effect of various clinical and angiographic factors on outcome. RESULTS: Mean patient age was 54 years (range, 29-88 years). Twenty-nine patients (36%) presented with poor-grade (World Federation of Neurologic Surgeons [WFNS] grade IV or V) SAH. Clinical deficits were global in 55 patients (70%), and angiographic vasospasm was diffuse in 53 (65%). Endovascular treatment consisted of transluminal angioplasty alone (18 procedures, 17%), intra-arterial papaverine infusion (65 procedures, 62%), or both (22 procedures, 21%). Unequivocal arterial dilatation was achieved in all but two patients, and major complications occurred in 2% of the procedures. Ten patients (12%) died in the hospital, and 36 (44%) recovered poorly. Permanent deficits attributable to cerebral vasospasm were present in 37 patients (52% of survivors). On multivariate logistic regression analysis, advanced age and poor WFNS grade at presentation were predictive of poor clinical outcome. CONCLUSION: Advanced age and poor clinical status at the time of SAH onset are predictive of poor clinical outcome despite endovascular treatment with angioplasty or intra-arterial papaverine in patients with symptomatic vasospasm.

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