Radiologic factors and anatomic arterial variants predict the development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Background: Delayed cerebral ischemia is a common complication after aneurysmal subarachnoid hemorrhage, which accounts for high morbidity and mortality in these patients. Predictors for this complication's development are necessary to ensure the prevention and adequate management of this complication. We aim to assess radiological features and anatomic variations as predictors of delayed cerebral ischemia. Methods: We performed a retrospective cohort analysis of a sample with aneurysmal subarachnoid hemorrhage between 2015 and 2019. Patients were classified according to the presence of delayed cerebral ischemia, and our statistical analysis sought predictors of delayed cerebral ischemia and bad neurological outcome. Results: Eighty-two patients were included in our study. Delayed cerebral ischemia occurred in 30 patients (36.6%). Hydrocephalus at admission (odds ratio [OR], 7.84; 95% confidence interval [CI], 2.02–52.75), intracerebral hematoma on initial computed tomography scan (OR, 5.80; 95% CI, 1.48–46.61), global cerebral edema (odds ratio [OR], 5.78; 95% confidence interval [CI], 1.61–110.59), anatomic variations (odds ratio [OR], 8.28; 95% confidence interval [CI], 2.81–232.41), higher values of systolic blood pressure on admission (odds ratio [OR], 6.56; 95% confidence interval [CI], 1.01–1.06), and smoking history (OR, 5.14; 95% CI, 1.35–64.92) were significantly associated with the development of delayed cerebral ischemia. Both anatomical variations (P = .018) and hydrocephalus (P = .019) were statistically correlated with a bad neurological outcome. Conclusions: Patients with anatomic variations and radiological injuries on admission are more likely to develop delayed cerebral ischemia during the hospital stay. A larger infarct territory can explain a worse neurological outcome in patients with anatomic variations.