• Jennifer A Frontera, Arjun Gowda, Christina Grilo, Errol Gordon, David Johnson, H Richard Winn, Joshua B Bederson, and Aman Patel.
• Departments of Neurosurgery and Neurology, Neuroscience Intensive Care Unit, Mount Sinai School of Medicine, New York, NY, USA. Jennifer.frontera@mountsinai.org
• Acta Neurochir. Suppl. 2011 Jan 1; 110 (Pt 2): 117-22.

Objectivesthe frequency and predictors of recurrent symptomatic and angiographic vasospasm after angioplasty or intra-arterial chemical vasodilatation (IACV) in patients with subarachnoid hemorrhage (SAH) are not well characterized.Methodsa retrospective review of serial clinical and angiographic data was conducted between 7/2001-6/2008 on spontaneous SAH patients who underwent endovascular therapy for symptomatic vasospasm.Resultsof 318 SAH patients, symptomatic vasospasm occurred in 80 (25%) and endovascular intervention was performed on 69 (22%) patients. Of these 69 patients, all received IACV in 274 vessels and 33 also underwent angioplasty in a total of 76 vessels. Recurrent angiographic vasospasm occurred in the same vessel segment in 9/23 (39%) patients who received both angioplasty + IACV compared to 40/49 (82%) of patients who received IACV alone (P < 0.001). Recurrent symptomatic vasospasm occurred in 10/26 (38%) angioplasty + IACV patients compared to 28/37 (76%) patients who received IACV alone (P = 0.003). The modified-Fisher Score, A1 spasm, distal and multi-vessel vasospasm predicted recurrent angiographic spasm after IACV alone (P < 0.05). Procedural complications occurred in 4% of IACV alone patients and 6% of angioplasty + IACV patients (P = 0.599).Conclusionsrecurrent angiographic or symptomatic vasospasm is not uncommon after angioplasty + IACV, but appears to occur significantly less than after IACV alone, without any increase in procedural complications.

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