To determine the effect of endovascular treatment (EVT) of cerebral vasospasm on functional outcomes among poor-grade subarachnoid hemorrhage (SAH) patients.

EVT of cerebral vasospasm in poor-grade SAH patients poses unique challenges due to difficulty in differentiating symptomatic and asymptomatic cerebral vasospasm and severe neurological injury prior to occurrence of vasospasm.   

We analyzed data from two tertiary stroke centers, focusing on poor grade SAH patients who required EVT for cerebral vasospasm. Poor-grade SAH patients were defined as those presenting with a Hunt and Hess/WFNS scale score of 4 or higher. EVT consisted of angioplasty and/or intraarterial vasodilators. Functional outcome was assessed at 90 days using the modified Rankin scale (mRS) score, categorized as 0-3 (favorable outcome) and 4-6 (unfavorable outcome), and 90-day mortality rate.

A total of 66 patients (mean age 52.4 ± 9.6 years, 40 were women) with poor-grade SAH required EVT for cerebral vasospasm. EVT consisted of primary angioplasty and/or intra-arterial vasodilator infusion in 66 and 26 patients, respectively. At 90 days, 36% (n=24) achieved a favorable functional outcome and mortality rate was 32% (n=21). Among patients with a favorable functional outcome at 90 days, 38% had received primary angioplasty compared with 24% in the unfavorable functional outcome group (p=0.167). Intra-arterial vasodilator infusion was used in 82% and 73% of patients in the favorable and unfavorable functional outcomes, respectively (p=0.372). The outcomes were comparable to poor grade SAH patients who did not require EVT for cerebral vasospasm (n=18), in whom favorable functional outcome and mortality rate were 33% and 22%, respectively.

Favorable functional outcomes can be seen in over one-third of poor-grade SAH patients who are receiving EVT for cerebral vasospasm, which was comparable to those who do not require treatment. Our results support use of EVT for cerebral vasospasm in poor grade SAH patients.