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      Vasospasm of the basilar artery following spontaneous SAH-clinical observations and implications for vascular research.

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          Abstract

          The basilar artery (BA), as a reference vessel for laboratory investigations of cerebral vasospasm (CVS) in many experimental models, warrants a sufficient blood supply despite hemodynamic changes during CVS. In a prospective evaluation study, we analyzed  patients who were admitted to our department with subarachnoid hemorrhage (SAH) for the occurrence and sequelae of CVS. Specifically, we sought to identify patients with CVS of the BA. As per institutional protocol, all patients with CVS detected in the posterior circulation had magnetic resonance imaging (MRI) examinations instead of CTA. Between January and December 2016, 74 patients were treated for spontaneous SAH. CVS occurred in 45 (61%) patients, and 31 (42%) patients developed associated cerebral infarctions (CI). CVS was significantly associated with CI (p < 0.0001; OR 44). In 18 (24.3%) patients, CVS significantly affected the basilar artery. Poor admission clinical state, younger age, and treatment modalities were significantly associated with BACVS. BACVS was more often detected in patients with severe CVS (p < 0.046; OR 4.4). Patients with BACVS developed cerebral infarction in a frequency comparable to other patients with CVS (61% vs. 70%, p = 0.7), but none of these infarctions occurred in the brain stem or pons even though vessel diameter was dramatically reduced according to CT- and/or MR-angiography. BACVS does not appear to be followed by cerebral infarction in the BA territory, presumably due to a vascular privilege of this vessel and its perforating branches. In contrast, brain ischemia can frequently be observed in the territories of other major arteries affected by CVS.

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          Author and article information

          Journal
          Neurosurg Rev
          Neurosurgical review
          Springer Science and Business Media LLC
          1437-2320
          0344-5607
          Dec 2019
          : 42
          : 4
          Affiliations
          [1 ] Department of Neurosurgery, Goethe University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. nazife.dinc@kgu.de.
          [2 ] Department of Neurosurgery, Goethe University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
          [3 ] Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany.
          [4 ] Department of Anesthesiology, Goethe University Hospital, Frankfurt, Germany.
          [5 ] Department of Biostatistics and Mathematical Modeling, Goethe University Hospital, Frankfurt, Germany.
          Article
          10.1007/s10143-018-1015-4
          10.1007/s10143-018-1015-4
          30088111
          af2cb3c1-8840-466f-9aaa-053a4a7ba65b
          History

          Subarachnoid hemorrhage,Cerebral vasospasm,Basilar artery

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