Abstract T P358: Impact of Clipping Versus Coiling on Postoperative Hemodynamics and Pulmonary Edema after Subarachnoid Hemorrhage
Introduction: Volume management is critical for assessment of vasospasm after aneurysmal subarachnoid hemorrhage (SAH). We compared the impact of surgical clipping versus endovascular coiling on postoperative hemodynamics and pulmonary edema.
Methods: This multicenter prospective cohort study measured hemodynamic parameters in patients with SAH using a transpulmonary thermodilution system (PiCCO Plus) from days 1 to 14. Parameters were compared according to treatment strategy.
Results: This study included 202 patients, including 160 who underwent clipping and 42 who underwent coiling. There were no differences in global ejection fraction (GEF), cardiac index, systemic vascular resistance index, or global end-diastolic volume index between the clipping and coiling groups in the early period. However, the pulmonary parameters, extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI), were significantly higher in the clipping group during the spasm period. Postoperative C-reactive protein (CRP) level was higher in the clipping group and correlated significantly with postoperative brain natriuretic peptide level. Multivariate analysis found that PVPI and GEF were independently associated with high EVLWI in the early period, suggesting cardiogenic edema (P=0.001 and P=0.004, respectively), and that CRP and PVPI, but not GEF, were independently associated with high EVLWI in the spasm period, suggesting non-cardiogenic edema (P=0.022, P=0.001, and P=0.507, respectively).
Conclusions: Postoperative hemodynamics were similar in both groups in the early period, but afterload mismatch may occur in the spasm period. Clipping affects postoperative CRP level and may thereby enhance non-cardiogenic pulmonary edema in the spasm period. Postoperative CRP level may predict pulmonary complications.
Trial Registration: University hospital Medical Information Network: UMIN000003794.
Author Disclosures: N. Horie: None. S. Ishizaka: None. T. Izumo: None. K. Hayashi: None. K. Suyama: None. I. Nagata: None.
- © 2014 by American Heart Association, Inc.