Risk factors for angiographic vasospasm and delayed cerebral ischemia subsequent to aneurysmal subarachnoid hemorrhage: A multicenter, registry study

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-02 DOI:10.1016/j.clineuro.2025.109136

Masahiro Hosogai , Fusao Ikawa , Daizo Ishii , Masashi Kuwabara , Yuyo Maeda , Kazunori Toyoda , Shotai Kobayashi , Nobutaka Horie , Japan Stroke Data Bank investigators

{"title":"Risk factors for angiographic vasospasm and delayed cerebral ischemia subsequent to aneurysmal subarachnoid hemorrhage: A multicenter, registry study","authors":"Masahiro Hosogai , Fusao Ikawa , Daizo Ishii , Masashi Kuwabara , Yuyo Maeda , Kazunori Toyoda , Shotai Kobayashi , Nobutaka Horie , Japan Stroke Data Bank investigators","doi":"10.1016/j.clineuro.2025.109136","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality. Symptoms of DCI can be categorized as temporary or permanent; however, the relationship between DCI and angiographic vasospasm (AVS) remains unclear. Therefore, this study aimed to clarify the relationship between DCI and AVS and to identify the factors associated with DCI in patients with aSAH.</div></div><div><h3>Methods</h3><div>Data from patients with acute aSAH who underwent surgical clipping or endovascular coiling within 72 h of onset in Japan between December 2016 and December 2020, were analyzed retrospectively. Univariable and multivariable logistic regression analyses were performed to identify factors associated with temporary or permanent DCI and AVS.</div></div><div><h3>Results</h3><div>AVS was identified in 27.3 % of 1066 patients with aSAH. Among these, 65.8 % did not develop DCI. DCI occurred in 13.4 % of patients, and 37.3 % of those with DCI did not experience AVS. AVS was associated with both temporary and permanent DCI in multivariable logistic regression analyses. Older age was associated with permanent DCI. Poor outcomes (defined as a modified Rankin Scale score of 3–6) at discharge were also associated with permanent (OR: 7.51, 95 % CI: 3.12–22.31) but not with temporary DCI or AVS.</div></div><div><h3>Conclusion</h3><div>Although AVS was significantly associated with both temporary and permanent DCI, DCI can occur without AVS. Older age was a risk factor for permanent DCI, which was associated with poor outcomes. This study may suggest the importance of management for DCI particularly in older patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109136"},"PeriodicalIF":1.6000,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurology and Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0303846725004196","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality. Symptoms of DCI can be categorized as temporary or permanent; however, the relationship between DCI and angiographic vasospasm (AVS) remains unclear. Therefore, this study aimed to clarify the relationship between DCI and AVS and to identify the factors associated with DCI in patients with aSAH.

Methods

Data from patients with acute aSAH who underwent surgical clipping or endovascular coiling within 72 h of onset in Japan between December 2016 and December 2020, were analyzed retrospectively. Univariable and multivariable logistic regression analyses were performed to identify factors associated with temporary or permanent DCI and AVS.

Results

AVS was identified in 27.3 % of 1066 patients with aSAH. Among these, 65.8 % did not develop DCI. DCI occurred in 13.4 % of patients, and 37.3 % of those with DCI did not experience AVS. AVS was associated with both temporary and permanent DCI in multivariable logistic regression analyses. Older age was associated with permanent DCI. Poor outcomes (defined as a modified Rankin Scale score of 3–6) at discharge were also associated with permanent (OR: 7.51, 95 % CI: 3.12–22.31) but not with temporary DCI or AVS.

Conclusion

Although AVS was significantly associated with both temporary and permanent DCI, DCI can occur without AVS. Older age was a risk factor for permanent DCI, which was associated with poor outcomes. This study may suggest the importance of management for DCI particularly in older patients.

查看原文本刊更多论文

动脉瘤性蛛网膜下腔出血后血管造影血管痉挛和迟发性脑缺血的危险因素：一项多中心登记研究

目的动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）是导致发病和死亡的主要原因。DCI的症状可分为暂时性和永久性；然而，DCI与血管造影血管痉挛（AVS）之间的关系尚不清楚。因此，本研究旨在阐明DCI与AVS之间的关系，并确定aSAH患者DCI的相关因素。方法回顾性分析2016年12月至2020年12月在日本发病72 h内接受手术夹持或血管内盘绕的急性aSAH患者的数据。进行单变量和多变量logistic回归分析，以确定与暂时性或永久性DCI和AVS相关的因素。结果1066例aSAH患者中有27.3% %存在savs。其中65.8% %未发生DCI。13.4% %的患者发生DCI， 37.3% %的DCI患者未发生AVS。在多变量logistic回归分析中，AVS与暂时性和永久性DCI相关。老年与永久性DCI相关。出院时不良预后（定义为修改的Rankin量表评分为3-6）也与永久性（OR: 7.51, 95 % CI: 3.12-22.31）相关，但与临时DCI或AVS无关。结论虽然AVS与暂时性和永久性DCI均有显著相关性，但无AVS也可发生DCI。年龄较大是永久性DCI的危险因素，与预后不良相关。这项研究可能提示管理DCI的重要性，特别是在老年患者中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.