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Method of Aneurysm Treatment Does Not Affect Clot Clearance After Aneurysmal Subarachnoid Hemorrhage
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Method of Aneurysm Treatment Does Not Affect Clot Clearance After Aneurysmal Subarachnoid Hemorrhage
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Journal Article
Method of Aneurysm Treatment Does Not Affect Clot Clearance After Aneurysmal Subarachnoid Hemorrhage
2012
Overview
Abstract
BACKGROUND
Patients undergoing neurosurgical clipping or endovascular coiling of a ruptured aneurysm may differ in their risk of vasospasm.
OBJECTIVE
Because clot clearance affects vasospasm, we tested the hypothesis that clot clearance differs in patients depending on method of aneurysm treatment.
METHODS
Exploratory analysis was performed on 413 patients from CONSCIOUS-1, a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). Clot clearance was measured by change in Hijdra score between baseline computed tomography and one performed 24 to 48 hours after aneurysm treatment. Angiographic vasospasm was assessed by the use of catheter angiography 7 to 11 days after SAH, and delayed ischemic neurological deficit (DIND) was determined clinically. Extended Glasgow Outcome Score (GOSE) was assessed 3 months after SAH, and poor outcome was defined as death, vegetative state, or severe disability. Multivariable ordinal and binary logistic regression were used.
RESULTS
There was no significant difference in the rate of clot clearance between patients undergoing clipping or coiling (P = .56). Coiling was independently associated with decreased severity of angiographic vasospasm (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.33-0.86), but not with DIND or GOSE. Greater clot clearance decreased the risk of severe angiographic vasospasm (OR 0.86, 95% CI 0.81-0.91), whereas higher baseline Hijdra score predicted increased angiographic vasospasm (OR 1.17, 95% CI 1.11-1.23) and poor GOSE (OR 1.09, 95% CI 1.04-1.14).
CONCLUSION
Aneurysm coiling and increased clot clearance were independently associated with decreased severity of angiographic vasospasm in multivariate analysis, although no differences in clot clearance were seen between coiled and clipped patients.
Publisher
Oxford University Press,Lippincott Williams & Wilkins,Wolters Kluwer Health, Inc
Subject
/ Biological and medical sciences
/ Endovascular Procedures - adverse effects
/ Endovascular Procedures - instrumentation
/ Female
/ Humans
/ Male
/ Pyrimidines - therapeutic use
/ Receptor, Endothelin A - agonists
/ Stroke
/ Subarachnoid Hemorrhage - complications
/ Subarachnoid Hemorrhage - surgery
/ Sulfonamides - therapeutic use
/ Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
/ Surgical Instruments - adverse effects
/ Tetrazoles - therapeutic use
/ Ultrasonography, Doppler, Transcranial
/ Vasospasm, Intracranial - diagnosis
