Prediction of vasospasms as complication in ischemic stroke patietns receiving anterior circulation endovascular stroke treatment

Background and Purpose: Vasospasms are a common and dreaded complication of endovascular stroke treatment (EST). There is a lack of understanding of risk factors for periprocedural vasospasms. Here, we aimed to identify prognostic factors for vasospasms in patients with acute ischemic stroke and EST. Methods: Retrospective single-center analysis of patients receiving EST for anterior circulation vessel occlusion between January 2015 and December 2021. Exclusion criteria were intracranial stenting and intraarterial (i.a.) thrombolysis. Study groups were defined as patients developing vasospasms during EST (V+) and patients, who did not (V-). The study groups were compared in univariate analysis. Further, multivariable regression models were developed to predict the patients' risk for developing vasospasms based on pre-identified potential prognostic factors. Secondary endpoint was clinical outcome as modified Rankin Scale (mRS) difference between pre-stroke mRS and discharge mRS (delta mRS). Results: In total, 132 of 1768 patients (7.5 %) developed vasospasms during EST in this study cohort. Patients with vasospasms were younger and had a lower pre-stroke disability (as per mRS). Vasospasms were more likely to occur in ESTs with multiple thrombectomy attempts in total and after several stent retriever maneuvers. Factors with predictive value for developing vasospasms were younger (OR = 0.967, 95%-CI = 0.96 - 0.98) and had a lower pre-stroke mRS (OR = 0.759, 95%-CI = 0.63 - 0.91). The prediction model incorporating patient age, pre-stroke mRS, stent retriever thrombectomy attempts, and total attempts as prognostic factors was found to predict vasospasms with decent accuracy (AUC = 0.714, 95%-CI = 0.709-0.720). V+ patients showed higher delta mRS (median (Q1 - Q3); V-: 2 (1-3) vs. V+: 2(1-4); p = 0.014). Conclusion: This study shows that vasospasms are a common complication in EST affecting younger and previously healthier patients and are more likely after multiple stent retriever thrombectomy attempts. As independent predictors patient age, pre-stroke mRS, thrombectomy maneuvers and stent-retriever attempts predict the occurrence of vasospasms during EST with decent accuracy.