Endovascular Therapy Outcomes for Cerebral Vasospasm in Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Background and Purpose

The impact of endovascular therapy (EVT) on outcomes in World Federation of Neurological Societies (WFNS) grade ≥ 4 aneurysmal subarachnoid hemorrhage (aSAH) remains unclear.

Methods

We conducted a retrospective cohort study of 80 patients with WFNS grade ≥ 4 aSAH and secondary vasospasm treated between 2010 and 2023. EVT included intra-arterial vasodilators and/or balloon angioplasty. The primary outcome was favorable functional status at 90 days (modified Rankin Scale 0–3). Multivariable logistic regression was used to assess associations between EVT and outcomes, adjusting for age, sex, and time-to-aneurysm securement.

Results

EVT was performed in 77.5% of patients (n = 62). Favorable outcomes occurred in occurred in 42.5% of all patients (n = 34), and were significantly more frequent in the EVT group (48.4% versus 22.2%; p = 0.038). EVT was independently associated with greater odds of favorable outcome (adjusted odds ratio [aOR] 3.15, 95% confidence interval [CI] 1.12–8.85; p = 0.030) and reduced mortality (aOR 0.24, 95% CI 0.07–0.82; p = 0.023). Early aneurysm treatment (≤ 12 h) also independently predicted favorable outcomes (aOR 2.38, p = 0.044) and lower mortality (aOR 0.42, p = 0.045).

Conclusions

Among patients with poor-grade aSAH and vasospasm, EVT was independently associated with improved functional outcomes and survival. These findings challenge historical nihilism and support timely, aggressive endovascular intervention as a critical component of care in this high-risk population.