Effect of Aneurysm Treatment Modalities on Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Abstract

Introduction: It is still controversial if the selection of treatment modality (clip or coil) affects cerebral vasospasm development following aneurysmal subarachnoid hemorrhage (SAH).

Materials and Methods: We enrolled 579 SAH patients in the Prospective Registry of Subarachnoid Aneurysms Treatment project, and these patients were treated either microsurgically or endovascularly within 12 days of onset. The incidence of vasospasm was compared between patients treated with clipping and coiling.

Results: Clipping (282 patients) was preferably performed for small aneurysms with a wide neck or middle cerebral artery aneurysms and was followed by cerebrospinal fluid drainage; coiling (297 patients) was preferred for older patients, larger, internal carotid artery and posterior circulation aneurysms, or treatment during a nonacute stage and more frequently followed by antithrombotic treatment. Univariate analyses showed that vasospasm-induced cerebral infarct occurred more frequently in clipped patients than in coiled patients, but this difference disappeared after multivariate analyses. Higher incidence of vasospasm-induced cerebral infarct after clipping was explained by the fact that clipping was selected more for the ruptured middle cerebral artery aneurysm with massive SAH or hematoma, in which vasospasm more frequently occurred.

Conclusions: Treatment modalities (clip or coil) may not significantly affect the incidence of vasospasm.

PRESAT group in Japan: Principal Investigator: Waro Taki, MD, PhD (Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu); Vice-principal Investigator: Nobuyuki Sakai, MD, PhD (Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe); Organizing and Protocol Committee: Akio Hyodo, MD, PhD (Department of Neurosurgery, Ryukyu University Hospital, Naha), Shigeru Nemoto, MD, PhD (Department of Endovascular Surgery, Jichi Medical University Hospital, Utsunomiya), Toshio Hyogo, MD, PhD (Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo), Tomoaki Terada, MD, PhD (Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama), Kouichi Satoh, MD, PhD (Department of Neurosurgery, Tokushima Red Cross Hospital, Tokushima), Naoya Kuwayama, MD, PhD (Department of Neurosurgery, Toyama University Hospital, Toyama), Shigeru Miyachi, MD, PhD (Department of Neurosurgery, Nagoya University Hospital, Nagoya), Masaki Komiyama, MD, PhD (Department of Neurosurgery, Osaka City General Hospital, Osaka), Masayuki Ezura, MD, PhD (Department of Neurosurgery, Sendai Medical Center, Sendai), Yuichi Murayama, MD, PhD (Department of Neurosurgery, Jikei University School of Medicine, Minato-ku), Hiroshi Sakaida, MD, PhD (Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu), Masayuki Maeda, MD, PhD (Department of Radiology, Mie University Graduate School of Medicine, Tsu), Hiroshi Nagai, MD, PhD (Foundation for Biomedical Research and Innovation Translational Research Informatics Center, Kobe); Neuroimaging Review Committee: Kimihiko Kichikawa, MD, PhD (Department of Radiology, Nara Medical University, Kashihara), Akihiro Uemura, MD, PhD (Department of Radiology, St. Luke’s International Hospital, Chuo-ku), Yuji Numaguchi, MD, PhD (Department of Radiology, St. Luke’s International Hospital, Chuo-ku), Suketaka Momoshima, MD, PhD (Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku), Sachio Kuribayashi, MD, PhD (Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku), Chiaki Sakai, MD, PhD (Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe); Participating Centers and Investigators: Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo (Toshio Hyogo, Taketo Kataoka), Department of Endovascular Neurosurgery, International Medical Center of Saitama Medical University, Hidaka (Shoichiro Ishihara), Department of Neurosurgery, Chiba Emergency Medical Center, Chiba (Yorio Koguchi, Shigeki Kobayashi), Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu (Yukiko Enomoto, Kiyofumi Yamada, Shinichi Yoshimura), Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai (Yasushi Matsumoto), Department of Neurosurgery, Kurume University Hospital, Kurume (Masaru Hirohata), Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe (Nobuyuki Sakai, Hidemitsu Adachi, Yasushi Ueno, Takeharu Kunieda, Chiaki Sakai, Hiroshi Yamagami, Hirotoshi Imamura, Masaomi Koyanagi, Kenichi Todo, Shiro Yamamoto, Yoji Kuramoto), Department of Neurosurgery, National Hospital Organization Mito Medical Center, Ibaraki (Makoto Sonobe, Noriyuki Kato), Department of Neurological Surgery, Nihon University School of Medicine, Itabashi-ku (Teruyasu Hirayama, Tsuneo Kano), Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi (Isao Naito), Department of Neurosurgery, Tokushima University Hospital, Tokushima (Shunji Matsubara, Junichiro Satomi, Koichi Satoh), Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu (Hidekazu Hamada, Naoki Toma, Fumio Asakura, Hidenori Suzuki, Hiroshi Sakaida, Satoshi Matsushima, Waro Taki), Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama (Tomoaki Terada), Department of Neuroendovascular Therapy, Sagamihara Kyodo Hospital, Sagamihara (Tadashi Shibuya), Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo-ku (Hidenori Oishi), Department of Neurosurgery, Tachikawa General Hospital, Nagaoka (Hiroshi Abe), Department of Neurosurgery, Kyorin University School of Medicine, Mitaka (Yoshifumi Konishi, Eishi Sato), Department of Neurosurgery, Hyogo Brain and Heart Center at Himeji, Himeji (Mitsugu Nakamura), Department of Neurosurgery, Kitazato University School of Medicine, Sagami (Akira Kurata), Department of Neurosurgery, Dokkyo Medicine University Koshigaya Hospital, Koshigaya (Katsumi Houya, Takanori Uchida, Akio Hyodo), Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu (Ichiro Nakahara, Toshio Higashi, Nozomi Murai, Yasushi Iwamuro, Yoshihiko Watanabe, Hideaki Nakagaki, Masahiro Takezawa, Daiki Murata), Department of Neurosurgery, Osaka City General Hospital, Osaka (Masaki Komiyama), Department of Neurosurgery, Jikei University School of Medicine, Minato-ku (Yuichi Murayama, Toshihiro Ishibashi, Takayuki Saguchi, Masaki Ebara, Hideki Arakawa, Koreaki Irie), Interventional Neuroradiology Center, Aizawa Hospital, Matsumoto (Hisashi Nagashima), Department of Neurosurgery, University of Toyama, Toyama (Naoya Kuwayama), Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama (Kenji Sugiu, Koji Tokunaga, Ayumi Nishida), Endovascular Neurosurgery, Jichi Medical University Hospital, Shimotsuke (Katsunori Nanba, Shigeru Nemoto), Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino (Masanori Tsutsumi, Kiyoshi Kazekawa), Department of Endovascular Neurosurgery, Toranomon Hospital, Minato-ku (Mikito Hayakawa, Yuji Matsumaru); Data Center and Statistical Analysis: Foundation for Biomedical Research and Innovation Translational Research Informatics Center, Kobe (Yoshihiro Matsubayashi, Tomomi Sakabayashi, Keiko Miyakoda, Wataru Oohashi, Masaki Sano, Emiko Uno, Makiko Toyooka, Kaori Kuronaka, Kazuro Sakamoto, Hiroshi Nagai, Masanori Fukushima).