Computed tomography perfusion as a predictor of delayed cerebral ischemia and functional outcome in spontaneous subarachnoid hemorrhage: A single center experience

Abstract

Background Computed tomography (CT) perfusion has been studied as a tool to predict delayed cerebral ischemia (DCI) and clinical outcome in spontaneous subarachnoid hemorrhage (SAH). The purpose of the study was to determine whether quantitative CT perfusion performed within 72 hours after admission can predict the occurrence of DCI and clinical outcome as measured with a modified Rankin scale (mRS) at 3 months after ictus. Methods Cerebral perfusion was assessed in a prospective cohort of patients with acute SAH. CT perfusion parameters at <72 h post SAH were quantitatively measured in the main vascular territories and represented as whole-brain means. Spearman rank correlation coefficient and generalized additive regression models for binary outcome were used. Results A total of 66 patients underwent CT perfusion at <72 h. Poor clinical grade on admission was correlated with worse cerebral perfusion in all parameters. Multivariable analysis yielded an association of time to peak (TTP; odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.77, 1.02; p = 0.083) with the occurrence of DCI. We also found an association of TTP values with poor outcome, with an 8% increase in the odds of mRS > 3 for each one second increase in TTP at admission (OR = 1.08; 95% CI: 1.00, 1.17; p = 0.061). Conclusions We identified an association of early TTP changes with DCI and poor clinical outcome. However, there were no associations with cerebral blood flow or mean transit time and DCI/clinical outcome. CT perfusion still remains to be validated as a tool in predicting outcome in SAH.

An international bibliometric study of scientific articles on intracranial aneurysms

“…1 High mortality and morbidity rates of ruptured intracranial aneurysms are still a serious health problem. 2 The survival rate after aneurysmal subarachnoid hemorrhage (SAH) has increased by 17% in the past few decades, probably owing to better diagnosis, early aneurysms repair, prescription of nimodipine, and advanced intensive care support. 3 Although the mortality rate related to acute SAH has decreased from 50% to 35% in recent years, there is still critical morbidity and mortality, which can be related to the fact that 25% of patients are deceased before reaching the hospital, the lack of specialists or equipment in the first hospital reached, and the continuing debates on the optimal management of aneurysmal SAH.…”

Small vessel disease in patients with subarachnoid hemorrhage: Prevalence and associations with vasospasm occurrence, severity and clinical outcomes

“…2 These cSVD markers have been consistently shown to The Neuroradiology Journal 2019, Vol. 32 (6) 438-444 strongly influence outcome in patients with ischemic stroke as well as primary intracerebral hemorrhage, hypothetically due to their cumulative impact on brain network efficiency, but also due to their associations with recurrence risk and independent higher susceptibility to ischemia. 3,4 On the other hand, aneurysmal subarachnoid hemorrhage (aSAH), a disease of larger sized vessels, is amongst the deadliest forms of stroke and, despite its relative scarcity, causes major healthcare consequences and represents an important socio-economic burden.…”

“…3,4 On the other hand, aneurysmal subarachnoid hemorrhage (aSAH), a disease of larger sized vessels, is amongst the deadliest forms of stroke and, despite its relative scarcity, causes major healthcare consequences and represents an important socio-economic burden. 5 Much of its morbi-mortality is due to cerebral vasospasm (CVS), maximal 7-10 days after onset, triggered by the presence of blood in the subarachnoid spaces, and associated with delayed cerebral ischemia (DCI), 6 persistent neurological deficits and long-term neurological disability. 7 Recent data have highlighted the role of white matter structural integrity in the early prognostication of patients with aSAH.…”

Impact of Implementing an Elaborated CT Perfusion Protocol for Aneurysmal SAH on Functional Outcome: CTP Protocol for SAH

“…imaging protocols for early prediction and detection of delayed cerebral ischemia (DCI) after aSAH. [4][5][6][7][8][9] Nevertheless, there is a substantial heterogeneity in the CTP protocols used in different centers, not allowing general conclusions concerning the beneficial role of CTP protocols for the management of patients with aSAH in clinical practice. Despite the increased use of CTP, its actual diagnostic and prognostic value has not yet been completely determined.…”