Factors for Vasospasm-Induced Cerebral Infarct When Both Clipping and Coiling Are Equally Available



Fig. 1
Incidence of vasospasm-induced cerebral infarct stratified by aneurysm location. () number of cases, P value chi-square test



With regard to outcomes (Table 1), the incidence of independent survival (mRS 0–2) was similar between clipping and coiling at both 3 (62.6 vs. 67.3 %) and 12 (67.3 vs. 71.4 %) months after SAH. Multivariate logistic regression with poor outcome (1-year mRS 3–6) as a binary outcome demonstrated vasospasm-induced cerebral infarct to be a significant prognostic factor when patient age, gender, admission WFNS grade, Fisher CT group, aneurysm location, dome size, neck size, pretreatment aneurysm rerupture (in hospital, n = 41, 7.6 %), treatment modality, antiplatelet therapy (n = 129, 24.0 %), CSF drainage (with/without irrigation, n = 365, 68.0 %), vasospasm-induced cerebral infarct (n = 95, 17.7 %), shunt-dependent hydrocephalus (n = 101, 18.8 %), epilepsy (n = 26, 4.8 %), infection (sepsis, pneumonia, etc.; n = 48, 8.9 %), noninfectious cardiopulmonary complications (n = 35, 6.5 %), clipping-related complications (n = 84, 15.6 %), and coiling-related complications (n = 52, 9.7 %) were used in the analyses (Table 2).


Table 1
Modified Rankin Scale (mRS) at 3 and 12 months after subarachnoid hemorrhage


















































































































Variable

Clip (n = 273)

Coil (n = 264)

P valuea

mRS at 3 months

n = 270

n = 263
 

 0

86 (31.9)

131 (49.8)

<0.001

 1

39 (14.4)

24 (9.1)

ns

 2

44 (16.3)

22 (8.4)

<0.01

 3

19 (7.0)

11 (4.2)

ns

 4

37 (13.7)

28 (10.6)

ns

 5

22 (8.1)

21 (8.0)

ns

 6

23 (8.5)

26 (9.9)

ns

 0–1

125 (46.3)

155 (58.9)

<0.005

 0–2

169 (62.6)

177 (67.3)

ns

mRS at 12 months

n = 263

n = 255
 

 0

105 (39.9)

145 (56.9)

<0.001

 1

36 (13.7)

25 (9.8)

ns

 2

36 (13.7)

12 (4.7)

<0.001

 3

21 (8.0)

13 (5.1)

ns

 4

25 (9.5)

17 (6.7)

ns

 5

14 (5.3)

14 (5.5)

ns

 6

26 (9.9)

29 (11.4)

ns

 0–1

141 (53.6)

170 (66.7)

<0.005

 0–2

177 (67.3)

182 (71.4)

ns


Number of cases (%)

ns not significant

aChi-square test



Table 2
Significant variables in multivariate logistic regression with poor outcome (1-year modified Rankin Scale 3–6) as a binary outcome











Variables

Odds ratio

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Nov 8, 2016 | Posted by in NEUROLOGY | Comments Off on Factors for Vasospasm-Induced Cerebral Infarct When Both Clipping and Coiling Are Equally Available

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