Introduction: Treatment of the sequale following aSAH such as vasospasm has evolved to include different options ranging from endovascular angioplasty to administration of intra-arterial calcium channel blockers and permissive hypertension. Our study examines trends of angioplasty for cerebral vasospasm usage in endovascularly treated aSAH.
Methods: We used Nationwide Inpatient sample data from 2002 to 2012. ICD9 codes 430, 431 and 432 in conjunction with ICD9 procedure code 39.72 (endovascular repair/embolization of head and neck vessel) were used to identify endovascularly treated aSAH patients (Excluding ICD9 747.81 - cerebral AVM). Cerebral vasospasm treated with angioplasty was identified with ICD procedure code 00.62 and 39.50. Patients requiring external ventricular drain (EVD) were also identified to stratify higher severity of aSAH. Comorbidities were controlled using Charlson’s Index. The population was divided into Age <50 and Age >=50 groups to understand differences in angioplasty trends in these groups, as there is evidence of increased risk of cerebral vasospasm in patients with age less than 50 years. Trend of angioplasty were evaluated using a multivariate model with survey logistics using SAS 9.2.
Results: We identified 9,856 hospitalizations with 62.6% in Age > 50 and 37.4% in Age < 50 group. Overall 4.04% in Age >50 and 5.80% in Age <50 group required angioplasty. In Age >50 group, Increasing year from 2002 to 2012 predicted decreased requirement of angioplasty with Odds Ratio(OR) of 0.935 (95% Confidence Interval (CI) 0.879-0.995, p=0.03) after controlling for increasing age, Chanrlson’s co-morbidity index and EVD placement; however the same trend was not statistically significant for Age < 5o (OR - 0.967, 95%CI 0.917-1.020, p=0.2150).
Conclusion: Decreasing trend of angioplasty for aSAH related cerebral vasospasm was observed during the past decade in population with age more than 50 years in our study. Advances in endovascular care such as administration of intra arterial calcium channel blockers as well as enhanced neuro-critical management of vasospasm may have contributed to a decrease in the trend of angioplasty treatment of vasospasm after aSAH.