Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Neurologia Medico-Chirurgica

Yoshihiro OMURA¹  Hirotoshi IMAMURA¹  Natsuhi SASAKI¹  Hidemitsu ADACHI¹  Shoichi TANI¹  Nobuyuki SAKAI¹  Nobuyuki FUKUI¹  Masashi SHIGEYASU¹  Ryu FUKUMITSU¹  Tadashi SUNOHARA¹  Kento ASAKURA¹  Tomoaki AKIYAMA¹  Ryo HORII¹  Tatsumaru FUKUDA¹  Shinji KAJIURA¹ 

[1] Department of Neurosurgery, Kobe City Medical Center General Hospital;

关键词: vasospasm;    surgical clipping;    endovascular coiling;    cilostazol;   

DOI  :  10.2176/jns-nmc.2021-0126

来源: DOAJ

【 摘 要 】

Vasospasm, initial neurological damage, rebleeding, and periprocedural complications are associated prognostic factors for clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH). In this study, factors related to delayed ischemic neurological deficit (DIND) are evaluated using data from our institute for the last 18 years. Data from 2001 to 2018 of patients with aneurysmal SAH who underwent surgical clipping (SC) or endovascular coiling (EC) within 7 days of onset were retrospectively analyzed. Cases of mortality within 5 days after treatment were excluded. Multivariate analysis was used to identify the risk factors for DIND. In total, 840 cases of SAH were assessed; among these cases, 384 (45.7%) and 456 (54.3%) were treated with SC and EC, respectively. The frequency of DIND in the EC group was significantly less than that in the SC group (11.8% vs. 17.7%; p = 0.016). In the results of multivariate analysis, internal carotid artery (ICA) aneurysm and hemorrhagic complications were the risk factors for DIND. Cilostazol administration and EC were significant factors for vasospasm prevention after aneurysmal SAH (odds ratio of ICA aneurysm: 1.59, hemorrhagic complications: 1.76, SC: 1.51, and cilostazol administration: 0.51, respectively). Cilostazol administration was also a significant factor in patients who were treated with EC. ICA aneurysm, treatment strategy, hemorrhagic complications, and cilostazol administration were associated with DIND. Oral administration of cilostazol and avoiding hemorrhagic complications were effective in DIND prevention. If both treatments are available for ruptured aneurysms, clinicians should choose EC on the basis of its ability to prevent DIND.

【 授权许可】

Unknown