Risk factors associated with vasospasm after non-traumatic subarachnoid hemorrhage: a retrospective analysis of 456 patients

Joos, GS; Gottschalk, A;Ewelt, C;Holling, M;Stummer, W;Englbrecht, JS

Abstract

BACKGROUND: The pathophysiology of vasospasm after non-traumatic subarachnoid hemorrhage is not completely understood. Several risk factors associated with vasospasm were previously reported, partially with conflicting results. The aim of this study was to identify patients at increased risk for vasospasm. METHODS: Retrospective analysis of data from all patients treated in our institutional intensive care unit (ICU) between 2010 and 2016 after non-traumatic subarachnoid hemorrhage. Possible contributing factors for vasospasm studied were: age, sex, aneurysmlocalization, treatment option, ICU-stay, ICU mortality, pre-existing condition, medication history, World Federation of Neurosurgical Societies (WFNS) grading system, modified Fisher scale. RESULTS: We obtained data from 456 patients. 184 were male and 272 female patients, respectively. Mean age was 57.7 ± 13.9 and was not different between sexes. In 119 patients, vasospasm was diagnosed after subarachnoid hemorrhage. Incidence of vasospasm was not different between sexes (male: 22.3%, female: 28.7%, p=0.127). Patients with vasospasm were significantly younger (mean age 52.2 vs. 59.7, p<0.001), meanwhile patients aged 36-40 yrs. had the highest incidence of vasospasm. Most vasospasm were found after rupture of middle cerebral artery-aneurysms. Higher incidence of vasospasm was found after aneurysm clipping compared to coiling. Vasospasm developed more often in patients with more severe WFNS grade and Fisher scale. In multivariate analysis, age, previous drug abuse and history of anticoagulants were associated with the incidence of vasospasm. CONCLUSIONS: Younger age, middle cerebral artery-aneurysms, aneurysm clipping, previous drug abuse and history of anticoagulants were associated with a higher incidence of vasospasm after non-traumatic subarachnoid hemorrhage. No gender difference was found.