Publication: Medical Treatment Failure for Symptomatic Vasospasm after Subarachnoid Hemorrhage Threatens Long-Term Outcome
Issued Date
2019-07-01
Resource Type
ISSN
15244628
00392499
00392499
Other identifier(s)
2-s2.0-85068810646
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Stroke. Vol.50, No.7 (2019), 1696-1702
Suggested Citation
Sureerat Suwatcharangkoon, Gian Marco De Marchis, Jens Witsch, Emma Meyers, Angela Velazquez, Cristina Falo, J. Michael Schmidt, Sachin Agarwal, E. Sander Connolly, Jan Claassen, Stephan A. Mayer Medical Treatment Failure for Symptomatic Vasospasm after Subarachnoid Hemorrhage Threatens Long-Term Outcome. Stroke. Vol.50, No.7 (2019), 1696-1702. doi:10.1161/STROKEAHA.118.022536 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/51572
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Medical Treatment Failure for Symptomatic Vasospasm after Subarachnoid Hemorrhage Threatens Long-Term Outcome
Abstract
© 2019 American Heart Association, Inc. Background and Purpose-Symptomatic vasospasm is a common cause of morbidity and mortality after subarachnoid hemorrhage. We sought to identify predictors and the long-term impact of treatment failure with hypertensive therapy for symptomatic vasospasm. Methods-We performed a retrospective analysis of 1520 subarachnoid hemorrhage patients prospectively enrolled in the Columbia University SAH Outcomes Project between August 1996 and August 2012. One hundred ninety-eight symptomatic vasospasm patients were treated with vasopressors to raise arterial blood pressure, with and without volume expansion. Treatment response, defined as complete or near-complete resolution of the initial neurological deficit, was adjudicated in weekly meetings of the study team based on serial clinical examination after hypertensive treatment. Outcome was evaluated at 1 year with the modified Rankin Scale. Results-Twenty-one percent of the 198 patients who received hypertensive therapy did not respond to treatment. Treatment failure was associated with an increased risk of death or severe disability at 1 year (modified Rankin Scale score of 4-6; 62% versus 25%; P<0.001). Failure of medical therapy was also associated with an admission troponin I level >0.3 μg/L (64% versus 28%; P=0.001), aneurysm coiling (43% versus 20%; P=0.004), and involvement of >1 symptomatic vascular territory at onset (39% versus 22%; P=0.02). In multivariable analysis, treatment failure was independently associated only with troponin I elevation (adjusted odds ratio, 4.30; 95% CI, 1.69-11.09; P=0.002). Conclusions-Failure to respond to induced hypertension for symptomatic vasospasm threatens 1-year outcome. Subarachnoid hemorrhage patients with symptomatic vasospasm who have elevated initial troponin I levels, indicative of neurogenic cardiac injury, are at twice the risk of medical treatment failure. Expedited endovascular therapy should be considered in these patients.