Understanding late-window cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

Cohort studyClinical neurology and neurosurgery· Aug 2026

Understanding late-window cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

Omar Alwakaa, Thomas Fodor, James Devanney … Alvin S Das

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Neurocritical CareCohort studyClinical practiceQ3IF 1.8

Delayed aneurysm treatment strongly linked to late-window cerebral vasospasm after hemorrhage

Understanding late-window cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

Omar Alwakaa … Alvin S Das

Clinical neurology and neurosurgery · Aug 2026 · Q3 in Neurology

Background

Cerebral vasospasm is a major determinant of neurologic outcome following aneurysmal subarachnoid hemorrhage (aSAH).

Purpose

In this study, we sought to determine the incidence of late-window vasospasm and identify its independent clinical and radiographic predictors.

Methods

With cerebral vasospasm identified on transcranial Doppler or CT angiography were selected from a prospectively maintained database of patients with aSAH admitted between 2003 and 2024.

n = 370 patients

Results

delayed treatment raised the odds of late vasospasm nearly ninefold

AOR by subgroup · 95% CI

More results

Among 370 patients with aSAH, 192 (51.9%) were diagnosed with vasospasm (median age 54 years [IQR 46-62]; 123 female).

Late-window vasospasm occurred in 27 patients (14.1%).

More results

In univariable analysis, female sex, smoking history, surgical aneurysm treatment, Fisher grade, and delayed aneurysm treatment (> 48 h after symptom onset) were significantly associated with late-window vasospasm.

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Conclusion · 1 of 2

Approximately one in seven patients with vasospasm experienced onset beyond 10 days. Higher Fisher grade and delayed aneurysm treatment were independently associated with late-window vasospasm.

Conclusion · 2 of 2

These findings suggest continued neurovascular surveillance beyond the first 10 days may be important for patients with these risk factors.

Understanding late-window cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

Understanding late-window cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

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