• Matthew J Kole, Juan Carlos Martinez-Gutierrez, Hussein A Zeineddine, TruongVan Thi ThanhVTTDepartment of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA., and Peng Roc Chen.
• Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA. mkole1@geisinger.edu.
• Neurocrit Care. 2024 Jun 1; 40 (3): 115111591151-1159.

BackgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) who survive the rupture are at risk for delayed neurologic deficits and cerebral infarction. The ideal method(s) of surveillance for cerebral vasospasm, and the link between radiographic vasospasm and delayed neurologic deficits, remain controversial. We instituted a postbleed day 7 angiography protocol with the stated goals of identification of vasospasm, improving neurologic outcomes, and possibly lowering cost of care.MethodsWe conducted a quality improvement project in which we retrospectively analyzed consecutive cases of aSAH from a single institution over a 5-year period. Patients were excluded if they did not receive treatment for their aneurysm or were < 18 years of age. We analyzed demographic and outcome information for patients managed by protocolled angiography versus those who were managed by as-needed endovascular rescue therapy. Statistical tests were performed comparing means and proportions in both cohorts, as appropriate.ResultsIn total, 223 patients were identified who met inclusion criteria. In total, 157 patients were identified in the protocolled day 7 angiography group, and 66 were in the nonprotocolled angiography group. Demographics were similar between the day 7 angiogram and medical management cohorts, except for a higher mean age among the latter group (p = 0.016). The protocolled angiography group underwent a significantly greater number of angiograms (p < 0.001) and had a significantly higher cost of hospitalization ($240,327 vs. $205,719, p = 0.03), with no significant difference in rate of cerebral infarction, length of intensive care unit stay, length of hospital stay, discharge location, or discharge modified Rankin Score.ConclusionsThis cohort comparison analysis draws into question the practice of protocolized cerebral angiography in patients with aSAH.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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