Predictors of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: A multivariable analysis of 506 patients.

BACKGROUND: Cerebral vasospasm (CVS) is a major contributor to delayed cerebral ischemia and poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). We aimed to identify independent predictors of CVS in a large contemporary aSAH cohort. METHODS: We retrospectively reviewed 506 adult patients with aSAH treated at a single tertiary center. Univariable and multivariable logistic regression were performed to identify independent predictors of CVS. RESULTS: Among 506 patients with aSAH, 90 (17.7%) developed cerebral vasospasm. Patients who developed vasospasm were younger than those without vasospasm (50.43 ± 12.87 vs. 55.36 ± 13.11 years; p = 0.001) and more frequently had modified Fisher grade 4, prior ischemic stroke, and decompressive hemicraniectomy (all p ≤ 0.001). On multivariable analysis, younger age (<52 years), decompressive hemicraniectomy, and hydrocephalus were independently associated with any vasospasm. Modified Fisher grade 3 and 4 showed borderline associations with any vasospasm (p < 0.10). For clinically significant (symptomatic) vasospasm, prior ischemic stroke and modified Fisher grade 3 and 4 were independently associated with increased odds of symptomatic vasospasm. CONCLUSION: In this multivariable analysis of 506 aSAH patients, On multivariable analysis, younger age (<52 years), decompressive hemicraniectomy, and hydrocephalus were independently associated with any vasospasm, while prior ischemic stroke and higher modified Fisher grade (grades 3 and 4) were independently associated with clinically significant vasospasm. These factors may help inform early risk stratification and targeted monitoring.