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10.3390/jcm15010168
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Calcification of the Internal Carotid Artery and Its Influence on the Severity of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

by
Adrian Engel
1,2,*,
Laurèl Rauschenbach
1,2,
Argtim Rexhepi
1,2,
Meltem Gümüs
1,2,
Christoph Rieß
1,2,
Jan Rodemerk
1,2,
Li Song
1,2,
Yan Li
3,
Börge Schmidt
4,
Yahya Ahmadipour
1,2,
Philipp Dammann
1,2,
Marvin Darkwah Oppong
1,2,
Ulrich Sure
1,2 and
Ramazan Jabbarli
1,2
1
Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany
2
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, 47057 Essen, Germany
3
Institute for Diagnostic and Interventional Radiology, University Hospital Essen, 45147 Essen, Germany
4
Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, 45147 Essen, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(1), 168; https://doi.org/10.3390/jcm15010168 (registering DOI)
Submission received: 12 November 2025 / Revised: 8 December 2025 / Accepted: 23 December 2025 / Published: 25 December 2025
(This article belongs to the Special Issue Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment—Second Edition)
Versions Notes

Abstract

Background/Objectives: Cerebral vasospasm (CV) is a serious complication of aneurysmal subarachnoid hemorrhage (aSAH). Carotid siphon calcification (CSC) has been associated with a reduced risk of CV. This study investigates the influence of CSC on the clinical and radiographic severity of CV and functional outcome of aSAH. Methods: A total of 475 patients with aSAH treated at the University Hospital Essen (2008–2016) were analyzed retrospectively. CSC was assessed using the Woodcock score. Study endpoints were the CV severity in digital subtraction angiography, presence of CV in transcranial Doppler (TCD) ultra-sonography, occurrence of delayed ischemic neurological deficit (DIND) and the functional outcome at 6 months measured with the modified Rankin scale. Results: CSC was confirmed as an independent predictor for the occurrence (aOR 0.76; 95% CI 0.60–0.97; p = 0.025) and severity (RC −0.14; 95% CI −0.24 to −0.04; p = 0.006) of angiographic CV and development of DIND (aOR 0.76; 95% CI 0.59–0.98; p = 0.034). Only the duration (in days: RC −0.43; 95% CI −0.77 to −0.10; p = 0.010) but not the presence (aOR 0.87; 95% CI 0.68 to 1.11; p = 0.265) and severity (cerebral blood flow, in cm/s: RC +1.57; 95% CI −7.45 to +10.58; p = 0.731) of TCD CV was associated with CSC. Finally, the increasing levels of CSC were related to poorer 6-month functional outcome (RC +0.12; 95% CI +0.05 to +0.18; p < 0.001). Conclusions: CSC appears to be protective against angiographic CV and DIND, but correlates with worse overall outcome, suggesting that atherosclerosis, represented by CSC, affects cerebrovascular regulation and overall prognosis. We suggest careful evaluation of primary imaging studies for markers of atherosclerosis to identify patients at risk for CV and patients with low risk for CV but still at high risk for poor outcome.
Keywords: subarachnoid hemorrhage; cerebral vasospasm; atherosclerosis subarachnoid hemorrhage; cerebral vasospasm; atherosclerosis

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MDPI and ACS Style

Engel, A.; Rauschenbach, L.; Rexhepi, A.; Gümüs, M.; Rieß, C.; Rodemerk, J.; Song, L.; Li, Y.; Schmidt, B.; Ahmadipour, Y.; et al. Calcification of the Internal Carotid Artery and Its Influence on the Severity of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. J. Clin. Med. 2026, 15, 168. https://doi.org/10.3390/jcm15010168

AMA Style

Engel A, Rauschenbach L, Rexhepi A, Gümüs M, Rieß C, Rodemerk J, Song L, Li Y, Schmidt B, Ahmadipour Y, et al. Calcification of the Internal Carotid Artery and Its Influence on the Severity of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. Journal of Clinical Medicine. 2026; 15(1):168. https://doi.org/10.3390/jcm15010168

Chicago/Turabian Style

Engel, Adrian, Laurèl Rauschenbach, Argtim Rexhepi, Meltem Gümüs, Christoph Rieß, Jan Rodemerk, Li Song, Yan Li, Börge Schmidt, Yahya Ahmadipour, and et al. 2026. "Calcification of the Internal Carotid Artery and Its Influence on the Severity of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage" Journal of Clinical Medicine 15, no. 1: 168. https://doi.org/10.3390/jcm15010168

APA Style

Engel, A., Rauschenbach, L., Rexhepi, A., Gümüs, M., Rieß, C., Rodemerk, J., Song, L., Li, Y., Schmidt, B., Ahmadipour, Y., Dammann, P., Darkwah Oppong, M., Sure, U., & Jabbarli, R. (2026). Calcification of the Internal Carotid Artery and Its Influence on the Severity of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. Journal of Clinical Medicine, 15(1), 168. https://doi.org/10.3390/jcm15010168

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