Abstract 157: Three‐Month Functional Outcomes in Poor Grade Aneurysmal Subarachnoid Hemorrhage Patients Undergoing Endovascular Treatment of Cerebral Vasospasm

Objective To determine the effect of endovascular treatment (EVT) of cerebral vasospasm on functional outcomes among poor‐grade subarachnoid hemorrhage (SAH) patients. Background 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. Methods 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 of vasospasm 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. Results The sample consisted of 80 patients (mean age 52.7 ± 10.1 years, 61% women) with poor‐grade SAH and cerebral vasospasm. EVT consisted of intra‐arterial vasodilator infusion in 62 patients, among which 24 had additional angioplasty. At 90 days, 39% (n=24) of those who received EVT achieved a favorable functional outcome, with 32% mortality rate. Among patients who received angioplasty, 54.2% achieved favorable outcomes versus 45.8% with unfavorable (p=0.167); Of those who underwent IA vasodilator therapy for vasospasm, 38.7% achieved favorable outcomes, and 61.2% had unfavorable outcomes (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. Conclusions Favorable functional outcomes can be seen in over one‐third of poor‐grade SAH patients who are treated with EVT for cerebral vasospasm, which was comparable to those who do not require treatment for cerebral vasospasm. Our results support use of EVT for cerebral vasospasm in poor grade SAH patients.