AUTHOR=Mielke Dorothee , Döring Katja , Behme Daniel , Psychogios Marios Nikos , Rohde Veit , Malinova Vesna 

TITLE=The Impact of Endovascular Rescue Therapy on the Clinical and Radiological Outcome After Aneurysmal Subarachnoid Hemorrhage: A Safe and Effective Treatment Option for Hemodynamically Relevant Vasospasm?

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.838456

DOI=10.3389/fneur.2022.838456

ISSN=1664-2295

ABSTRACT=Objective: Cerebral vasospasm (CVS) represents one of multiple contributors to delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Especially the management of CVS, refractory to medical treatment, is a challenging task during the acute phase after aSAH. Endovascular rescue therapies (ERT), such as medical or mechanical dilation are possible treatment options considered on an individual basis. However, data about the influence on the patients’ functional outcome is limited. The aim of this study was to assess the impact of ERT on the long-term functional outcome in aSAH-patients with refractory CVS. 

Methods: We performed a retrospective analysis of aSAH patients treated between 2012 and 2018. CVS was considered refractory, if it persisted despite the oral/intravenous nimodipine application as well as induced hypertension. The decision to perform ETR was made on an individual basis, according to the detection of “tissue at risk” on computed tomography perfusion (CTP) scans and CVS on computed tomography angiography (CTA) or digital subtraction angiography (DSA). The functional outcome was assessed according to the modified Rankin scale (mRS) 3 months after the ictus, whereas a mRS≤2 was considered as good outcome.

Results: A total of 268 patients were included. 205 patients (76.5%) were treated without ERT (group 1) and 63 patients (23.5%) with ERT (group 2). In 20 patients (31.8%) balloon dilatation was performed, in 23 patients (36.5%) solely intraarterial nimodipine injection and in 20 patients (31.8%) both procedures were combined. Considering only the patient group with DCI, the patients who were treated with ERT had a significantly better outcome compared to the patients without ERT (Mann-Whitney test, p=0.02). 

Conclusion: ERT resulted in a significantly better functional outcome in patients DCI compared to the patient group treated without ETR. CTP and CTA-based identification of “tissue at risk” might be a reliable tool for patient selection with a need for ERT.