{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:26:06Z","timestamp":1791350766868,"version":"4.3.1"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2011,4]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>The pathogenesis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage remains incompletely understood. It is generally assumed that it is caused by angiographic vasospasm. Our aim was to clarify the relationship among angiographic vasospasm, neurological worsening, cerebral infarction, and poor outcome and to investigate whether cerebral infarction also contributes to poor outcome by vasospasm-independent effects.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>This exploratory analysis used data from 413 patients included in the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial. We studied the incidence of neurological worsening, cerebral infarction, and poor outcome in patients with and without angiographic vasospasm. Path analysis implemented by structural equation modeling was performed to determine direct and indirect path coefficients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>Of the 194 patients with moderate to severe vasospasm, 43% had neurological worsening of any cause, 20% had cerebral infarction, and 46% poor outcome. Path coefficients for direct effects on poor outcome were 0.20 for World Federation of Neurological Surgeons Grade 4 to 5, 0.13 for history of hypertension, 0.19 for angiographic vasospasm, 0.16 for neurological worsening, and 0.11 for new cerebral infarction. Cerebral infarction contributed to poor outcome by vasospasm-dependent and -independent effects.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Our data show that the majority of patients with moderate to severe angiographic vasospasm did not have neurological worsening of any cause or cerebral infarction. Besides, cerebral infarction also has a direct effect on outcome independent of angiographic vasospasm. This suggests that other coexisting factors might be involved in the pathogenesis of delayed cerebral ischemia, which should also be an important research target to improve outcome after subarachnoid hemorrhage.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.110.597914","type":"journal-article","created":{"date-parts":[[2011,2,11]],"date-time":"2011-02-11T01:12:55Z","timestamp":1297386775000},"page":"924-929","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":303,"title":["Cerebral Infarction After Subarachnoid Hemorrhage Contributes to Poor Outcome by Vasospasm-Dependent and -Independent Effects"],"prefix":"10.1161","volume":"42","author":[{"given":"Mervyn D.I.","family":"Vergouwen","sequence":"first","affiliation":[{"name":"From the Department of Medicine (M.D.I.V.), the Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; the Division of Neurosurgery (D.I., R.L.M.), St Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and Department of Experimental Vascular Medicine (M.D.I.V.), Academic Medical Center, University of Amsterdam, Amsterdam, the..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Ilodigwe","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (M.D.I.V.), the Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; the Division of Neurosurgery (D.I., R.L.M.), St Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and Department of Experimental Vascular Medicine (M.D.I.V.), Academic Medical Center, University of Amsterdam, Amsterdam, the..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Loch","family":"Macdonald","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (M.D.I.V.), the Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; the Division of Neurosurgery (D.I., R.L.M.), St Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and Department of Experimental Vascular Medicine (M.D.I.V.), Academic Medical Center, University of Amsterdam, Amsterdam, the..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.36.3.329"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.68.3.337"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000133132.76983.8e"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181dd42b3"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-009-0575-y"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000255396.23280.31"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.108.519942"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(74)91639-0"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.20.7.864"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.1998.15.573"},{"key":"e_1_3_3_12_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/B0-12-369398-5\/00483-7","volume-title":"Encyclopedia of Social Measurement","author":"Lleras C","year":"2005","unstructured":"Lleras C. 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