Microsurgical Vascular Manipulation in Aneurysm Surgery and Delayed Ischemic Injury

Muhammad Omar Chohan, Andrew P. Carlson, Cristina Murray-Krezan, Christopher L. Taylor, Howard Yonas

Research output: Contribution to journalArticle

Abstract

Background: The role of aggressive surgical manipulation with clot evacuation, arachnoid dissection, and papaverine-guided adventitial dissection of large vessels during ruptured aneurysm surgery in reducing vasospasm is controversial. Here we describe a single-institution experience in aneurysm surgery outcomes with and without aggressive surgery. Methods: We performed retrospective analysis of all patients >18 years of age with subarachnoid hemorrhage (SAH) from anterior circulation aneurysms between 2008 and 2013 at the University of New Mexico Hospital. Vasospasm was characterized on days 3 through 14 after SAH based on: (1) angiography, (2) vasospasm requiring angiographic intervention, (3) development of delayed ischemic neurologic deficit (DIND), and (4) radiological appearance of new strokes. Results: Of 159 patients, 114 (71.6%) had aggressive and 45 (28.3%) had standard microsurgery. More than 60% of patients presented with a Hunt and Hess score of ≥3 and a Fisher grade (FG) of 4. Compared with standard surgery, there was a statistically significant decrease in the incidence of DIND in patients undergoing aggressive surgery (18.4% vs 37.8%, p=0.01). Moreover, there was a reduction in the number of new strokes by 30% in the aggressive surgery group with moderate or higher degrees of vasospasm (46.0% vs 76.5%, p=0.06). In the same group with FG 4 SAH, however, this difference was more than 50% (30% vs 64.7%, p=0.02). Conclusions: We conclude that aggressive surgical manipulation during aneurysm surgery results in lower incidence of DIND and new strokes. This effect is most pronounced in patients with FG 4 SAH.

Original languageEnglish (US)
Pages (from-to)410-414
Number of pages5
JournalCanadian Journal of Neurological Sciences
Volume44
Issue number4
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Fingerprint

Aneurysm
Blood Vessels
Subarachnoid Hemorrhage
Wounds and Injuries
Neurologic Manifestations
Stroke
Dissection
Arachnoid
Adventitia
Papaverine
Ruptured Aneurysm
Microsurgery
Incidence
Angiography

Keywords

  • Aneurysm
  • Clipping
  • Delayed ischemic neurologic deficit (DIND)
  • Infarct
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Microsurgical Vascular Manipulation in Aneurysm Surgery and Delayed Ischemic Injury. / Chohan, Muhammad Omar; Carlson, Andrew P.; Murray-Krezan, Cristina; Taylor, Christopher L.; Yonas, Howard.

In: Canadian Journal of Neurological Sciences, Vol. 44, No. 4, 01.07.2017, p. 410-414.

Research output: Contribution to journalArticle

Chohan, Muhammad Omar ; Carlson, Andrew P. ; Murray-Krezan, Cristina ; Taylor, Christopher L. ; Yonas, Howard. / Microsurgical Vascular Manipulation in Aneurysm Surgery and Delayed Ischemic Injury. In: Canadian Journal of Neurological Sciences. 2017 ; Vol. 44, No. 4. pp. 410-414.
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abstract = "Background: The role of aggressive surgical manipulation with clot evacuation, arachnoid dissection, and papaverine-guided adventitial dissection of large vessels during ruptured aneurysm surgery in reducing vasospasm is controversial. Here we describe a single-institution experience in aneurysm surgery outcomes with and without aggressive surgery. Methods: We performed retrospective analysis of all patients >18 years of age with subarachnoid hemorrhage (SAH) from anterior circulation aneurysms between 2008 and 2013 at the University of New Mexico Hospital. Vasospasm was characterized on days 3 through 14 after SAH based on: (1) angiography, (2) vasospasm requiring angiographic intervention, (3) development of delayed ischemic neurologic deficit (DIND), and (4) radiological appearance of new strokes. Results: Of 159 patients, 114 (71.6{\%}) had aggressive and 45 (28.3{\%}) had standard microsurgery. More than 60{\%} of patients presented with a Hunt and Hess score of ≥3 and a Fisher grade (FG) of 4. Compared with standard surgery, there was a statistically significant decrease in the incidence of DIND in patients undergoing aggressive surgery (18.4{\%} vs 37.8{\%}, p=0.01). Moreover, there was a reduction in the number of new strokes by 30{\%} in the aggressive surgery group with moderate or higher degrees of vasospasm (46.0{\%} vs 76.5{\%}, p=0.06). In the same group with FG 4 SAH, however, this difference was more than 50{\%} (30{\%} vs 64.7{\%}, p=0.02). Conclusions: We conclude that aggressive surgical manipulation during aneurysm surgery results in lower incidence of DIND and new strokes. This effect is most pronounced in patients with FG 4 SAH.",
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