• O O Zaidat, C C Ionita, S I Hussain, M J Alexander, A H Friedman, and C Graffagnino.
• Department of Neurology and Neurosurgery, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI 53226, USA. szaidat@mcw.edu
• J Neuroimaging. 2009 Apr 1; 19 (2): 144-9.

BackgroundThis study assessed the impact of treatment modality of aneurysmal subarachnoid hemorrhage (aSAH) on the rate of vasospasm (VSP), mortality, and hospital length of stay (LOS) of patients with aneurysmal subarachnoid hemorrhage (aSAH).MethodsWe analyzed patients with aSAH admitted between 1999 and 2005 undergoing either endovascular coiling (EC) or surgical clipping (SC) within 72 hours of onset. Clinical VSP was defined as neurological deficits unexplained by another etiology. Radiological VSP was defined based on transcranial Doppler (TCD) ultrasound, digital subtraction angiography (DSA), and CT criteria. Bivariate and logistic regression analysis was used to determine VSP predictors.ResultsOf 216 patients included, 98 (45%) underwent EC and 118 (55%) underwent SC. Clinical VSP was found in 26% of EC and 40% of SC patients (P < .03). TCD VSP, angiographic VSP, and CT infarctions were all significantly higher in the SC group. Mortality was similar in both groups however the LOS was longer in the SC patients (P= .03). Multivariate analysis showed that SC doubled the risk of clinical VSP (P < .03) and tripled the risk of composite VSP (P < .0006).ConclusionsOur study reveals that EC has a lower rate of VSP, shorter LOS, and comparable mortality to SC in aSAH.

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