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(Stroke. 2006;37:2738.)
© 2006 American Heart Association, Inc.

Original Contributions

Impact of Basilar Artery Vasospasm on Outcome in Patients With Severe Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Gill E. Sviri, MD, MSc; David W. Newell, MD; David H. Lewis, MD; Colleen Douville, BA, RVT; Basavaraj Ghodke, MD; Minku Chowdhary, MD; Arthur M. Lam, MD; David Haynor, MD; Menashe Zaaroor, MD, DSc Gavin W. Britz, MD, MPH

From the Department of Neurosurgery (G.E.S., D.H.L., M.Z.), Rambam (Maimonides) Medical Center, Haifa, Israel; Swedish Medical Center/Providence Campus (D.W.N., C.D.), Seattle Neuroscience Institute, Seattle Wash; and the Departments of Neurological Surgery (M.C., G.W.B.), Radiology (B.G., D.H.), and Anesthesiology (A.M.L.), Harborview Medical Center, University of Washington, Seattle.

Correspondence to Gill E. Sviri, MD, MSc, Department of Neurosurgery, Rambam (Maimonides) Medical Center, Haifa, Israel. E-mail sviri{at}u.washington.edu

Background and Purpose— The purpose of the present study was to evaluate the impact of basilar artery (BA) vasospasm on outcome in patients with severe vasospasm after aneurysmal subarachnoid hemorrhage (aSAH).

Methods— Sixty-five patients with clinically suspect severe cerebral vasospasm after aSAH underwent cerebral angiography before endovascular treatment. Vasospasm severity was assessed for each patient by transcranial Doppler measurements, angiography, and ^99mTc-ethylcysteinate dimer single-photon emission computed tomography (ECD-SPECT) imaging. Percentage of BA narrowing was calculated in reference to the baseline angiogram.

Results— BA narrowing 25% was found in 23 of 65 patients, and delayed brain stem (BS) hypoperfusion, as estimated by ECD-SPECT, was found in 16. Fourteen of 23 patients with BA narrowing 25% experienced BS hypoperfusion, whereas only 2 of 42 patients with 25% BA narrowing experienced BS ischemia (P<0.001). Stepwise logistic regression after adjusting for age with Hunt and Hess grade, Fisher grade, hydrocephalus, and aneurysmal location as covariables revealed BA narrowing 25% and delayed BS hypoperfusion to be significantly and independently associated with unfavorable 3-month outcome (P=0.0001; odds ratio, 10.1; 95% CI, 2.5 to 40.8; and P=0.007; odds ratio, 13.8, 95% CI, 2.18 to 91.9, respectively).

Conclusions— These findings suggest for the first time that BA vasospasm after aSAH is an independent and significant prognostic factor associated with poor outcome in patients with severe cerebral vasospasm requiring endovascular therapy. Further study should be done to evaluate the role of interventional therapy on outcome in patients with posterior circulation vasospasm.

Key Words: angiography • basilar artery • cerebral blood flow • single-photon emission computed tomography • subarachnoid hemorrhage • vasospasm