Comparing the frequency of symptomatic cerebral vasospasm and vasospasm-related ischemia in Fisher 3 grade ruptured anterior communicating artery aneurysms treated via microsurgical clipping or endovascular coiling

Abstract

Background and purpose: Ischemia due to cerebral vasospasm still remains an important cause of morbidity and mortality after aneurysmal SAH. Studies that compared the incidence of ischemia due to vasospasm between clip and coil therapies are still controversial. We compared vasospasm-induced ischemia rates between clip and coil therapies for ruptured anterior communicating artery aneurysms. Materials and methods: We retrospectively analyzed cases of ruptured anterior communicating artery treated with clips or coils within 36 h after rupture. Patients with Glasgow Coma Scale scores < 13; Fisher grades of 1, 2, or 4; multiple aneurysms; aneurysms associated with an arteriovenous malformation; stent- or balloon-assisted coiling; and complications during or after the clipping and coiling procedure were excluded from the study. Results: Although the incidence rates of ischemia and symptomatic vasospasm were higher in the coil group, no statistically significant difference was found between the two groups (P = 0.278 and P = 0.270, respectively). Conclusion: We found no significant difference in the incidence of vasospasm-induced ischemia between the patients treated with clipping and those treated with coil therapy who had Fisher grade 3 SAH and good clinical conditions. The amount of blood in basal cisterns on computed tomography, vascular manipulation, and brain retraction had the same triggering effect on vasospasm-induced ischemia.

Keywords

• Endovascular coil
• Microsurgical clip
• Subarachnoid hemorrhage
• Symptomatic vasospasm
• Ischemia