UPmémoires

English

Assessment of carotid termination spasm measurement as a predictor for endovascular treatment in vasospasm following aneurysmal subarachnoid hemorrhage

Introduction: To evaluate the utility of terminal Internal Carotid Arteries (ICA) spasm measurement as a predictor for endovascular treatment in vasospasm, after aneurysmal SubArachnoid Hemorrhage (SAH). The secondary outcome was to determine whether a morphologic vasospasm of the terminal ICA was independently associated with a risk of Delayed Cerebral Ischemia (DCI).

Methods: All patients who were hospitalized at CHU of Poitiers with acute aneurysmal SAH and underwent Computed Tomography Angiography (CTA) and Perfusion Computed Tomography (PCT) for vasospasm screening were retrospectively identified. Weighted Logistic Regression was used to establish a correlation between the presence of a severe terminal ICA spasm and the indication for endovascular treatment, then with DCI. We then calculated diagnostic performance measures for endovascular treatment at different spasm levels.

Results: The initiation of endovascular treatment was more likely in case of spasm of the terminal ICA, even more when a severe vasospasm was detected with a strong correlation. We determined a specificity of 98% for endovascular treatment at a spasm level over 47%.

The risk of DCI was significantly associated with the presence of a vasospasm of the terminal ICA, with a 6-fold higher risk if a mild or severe vasopasm was detected during follow-up.

Conclusion: We demonstrated a strong correlation between the presence of a severe spasm of the terminal ICA and the necessity of an endovascular treatment and an excellent specificity of 98% at a spasm level over 47%. Our study provides arguments for the indication of endovascular treatment in cases of severe vasospasm of at least one terminal ICA on CTA during aneurysmal SAH follow-up.

Keywords : Aneurysmal SubArachnoid Hemorrhage, Vasospasm, Terminal Internal Carotid, Endovascular treatment, Computed Tomography Angiography.