Abstract Details

Title Association Between Intracranial Atherosclerosis Burden and Outcomes in Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-018

Background Cerebral vasospasm is a common complication after aSAH, occurring more often in younger patients. We hypothesized that intracranial atherosclerosis, seen predominantly in older patients, affects vasospasm risk in aSAH.

Objective To test the association between intracranial atherosclerosis burden with vasospasm and outcomes in aneurysmal subarachnoid hemorrhage (aSAH).

Design/Methods We performed a retrospective study of a prospectively collected cohort of consecutive patients with aSAH admitted to an academic center between 2016 and 2023. Intracranial atherosclerosis burden was quantified by using modified Woodcock (MW) score on CT angiograms. Vasospasm was defined based on transcranial Doppler (TCD) criteria. Worse outcome was defined as 3-month modified Rankin Scale 4-6. Univariable and multivariable logistic regression were used to test the association of predictors with outcomes.

Results We reviewed 302 cases of aSAH (mean age 56.8 years [SD 13.3], 65% female, 70% white). Cerebral vasospasm was reported in 46% of patients and was more common in younger patients (OR 0.91 for each year increase, 95% CI 0.89-0.94; p<0.001). MW scores ranged from 0 to 3 (median 0, IQR 0-1) with higher scores in older patients (beta coefficient 0.019, 95% CI 0.009-0.028; p<0.001). Higher MW score was associated with lower risk of vasospasm (odds ratio 0.52 per point increase, 95% CI 0.36-0.78; p=0.001). There was an inverse correlation between MW scores and severity of vasospasm (beta coefficient -0.29, 95% CI -0.48, -0.1; p=0.003). However, MW score was not independently associated with worse functional outcome (p=0.62) when adjusted for age, Hunt and Hess grades, modified Fisher scores.

Conclusions Intracranial atherosclerosis is a potential mechanism for lower vasospasm rate in older SAH patients, however, it does not appear to alter functional outcome. This possibly suggests intracranial atherosclerosis may affect TCD velocities without any clinical correlation. Larger prospective studies are needed to confirm our findings.

Authors/Disclosures
Alex Hernandez Manriquez PRESENTER	No disclosure on file
Milidu Jayaweera	No disclosure on file
Asghar Shah	No disclosure on file
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology)	Dr. Stretz has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Shadi Yaghi, MD	Dr. Yaghi has nothing to disclose.
Ali Mahta, MD (Brown University)	Dr. Mahta has nothing to disclose.