Dominance of the anterior cerebral artery as a predictor of vasospasm related cerebral infarction after surgical treatment of ruptured blood blister-like aneurysm in the internal carotid artery.

Abstract

OBJECTIVE\nVasospasm (VSP) related ischemic complications are associated with poor outcomes in patients with subarachnoid hemorrhage (SAH) due to ruptured blood blister-like aneurysms (BBAs) in the communicating segment of the internal carotid artery (ICA). The purpose of this study was to investigate the incidence of and factors related to VSP related cerebral infarction (VSP-CI) in patients with surgically treated BBAs in the communicating segment of the ICA.\n\n\nMETHODS\nMedical records of 25 consecutive patients with surgically treated BBA in the communicating segment of the ICA were reviewed. Preoperative angiographic findings, surgical methods used, and patient outcomes including VSP-CI were evaluated.\n\n\nRESULTS\nOf the 25 patients, 10 underwent extracranial-intracranial (EC-IC) bypass with trapping and 15 underwent clipping surgery. VSP-CI occurred in the ipsilateral hemisphere to the aneurysm in 4 patients with EC-IC bypass with trapping and in 6 patients that received clipping. Positive findings of balloon test occlusion did not affect the occurrence of VSP-CI in the group of EC-IC bypass and trapping. The occurrence of VSP-CI was significantly higher in the patients with dominant anterior cerebral artery (ACA) ipsilateral to the aneurysm on preoperative angiography (P = 0.023) with a hazard ratio of 14.14 (95% confidence interval 1.57-127.68).\n\n\nCONCLUSIONS\nThe result of preoperative balloon test occlusion was less reliable for predicting postoperative ischemic complications of EC-IC bypass with trapping in patients with ruptured BBA in the communicating segment of the ICA. However, ACA dominance ipsilateral to the ruptured aneurysm can be predictive for postoperative VSP-CI.