Early Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Rooij, Nicolien K. de; Greving, Jacoba P.; Rinkel, Gabriël J.E.; Frijns, Catharina J.M.

doi:10.1161/strokeaha.113.001125

Cited by 95 publications

(93 citation statements)

References 26 publications

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“…24 The VASOGRADE derived from the studies published by de Rooij et al 15 and Crobeddu et al, 16 who developed risk charts to predict who would or would not develop DCI, respectively, combining the WFNS 9 and the modified Fisher scales.…”

Section: Discussionmentioning

confidence: 99%

“…The main idea was to create an ease-to-remember, ease-to-use, and practical grading system that would allow clinicians to tailor monitoring strategies and treatment aggressiveness according to the different grades. The VASOGRADE derived from previously published studies by de Rooij et al 15 and Crobeddu et al, 16 which showed clinical condition on admission and the amount of blood on CT (associated with age), as the major risk factors for DCI and DCI-related cerebral infarction. This analysis represents, therefore, the external validation of de Rooij et al, 15 in a large and diverse sample of SAH patients.…”

Section: Strokementioning

confidence: 99%

“…17 This analysis presents the external validation of a simple grading scale, the VASOGRADE (Figure 1), which was developed to predict DCI. The ingredients for the VASOGRADE were largely derived from de Rooij et al 15 (ie, WFNS grade and modified Fisher scale [9][10][11] ) and Crobeddu et al 16 and validated in a large group of SAH patients.…”

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confidence: 99%

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The VASOGRADE

Manoel¹,

Jaja

Germans³

et al. 2015

Stroke

106

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Background and Purpose— Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale—the VASOGRADE—for prediction of DCI. Methods— We used data of 3 phase II randomized clinical trials and a single hospital series to assess the relationship between the VASOGRADE and DCI. The VASOGRADE derived from previously published risk charts and consists of 3 categories: VASOGRADE-Green (modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale [WFNS] 1 or 2); VASOGRADE-Yellow (modified Fisher 3 or 4 and WFNS 1–3); and VASOGRADE-Red (WFNS 4 or 5, irrespective of modified Fisher grade). The relation between the VASOGRADE and DCI was assessed by logistic regression models. The predictive accuracy of the VASOGRADE was assessed by receiver operating characteristics curve and calibration plots. Results— In a cohort of 746 patients, the VASOGRADE significantly predicted DCI ( P <0.001). The VASOGRADE-Yellow had a tendency for increased risk for DCI (odds ratio [OR], 1.31; 95% CI, 0.77–2.23) when compared with VASOGRADE-Green; those with VASOGRADE-Red had a 3-fold higher risk of DCI (OR, 3.19; 95% CI, 2.07–4.50). Studies were not a significant confounding factor between the VASOGRADE and DCI. The VASOGRADE had an adequate discrimination for prediction of DCI (area under the receiver operating characteristics curve=0.63) and good calibration. Conclusions— The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients, which allows DCI risk stratification on presentation after subarachnoid hemorrhage. It could help to select patients at high risk of DCI, as well as standardize treatment protocols and research studies.

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Section: Discussionmentioning

confidence: 99%

Section: Strokementioning

confidence: 99%

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The VASOGRADE

Manoel¹,

Jaja

Germans³

et al. 2015

Stroke

106

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“…16 We and others have observed relationships between Fisher grade, HH score, and increasing age with acute and/or long-term outcomes. 17,18 Our multivariate analysis showed that 20-HETE CSF levels/trajectory groups remained strongly associated with acute and long-term outcomes and mortality after controlling for Fisher grade and HH score, respectively. These studies suggest that 20-HETE may serve as a potential biomarker of acute and long-term outcomes and mortality in patients with aSAH.…”

Section: Discussionmentioning

confidence: 80%

20-HETE is Associated with Unfavorable Outcomes in Subarachnoid Hemorrhage Patients

Donnelly

Crago

Conley

et al. 2015

J Cereb Blood Flow Metab

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Emerging evidence has suggested that patients experiencing aneurysmal subarachnoid hemorrhage (aSAH) develop vascular dysregulation as a potential contributor to poor outcomes. Preclinical studies have implicated the novel microvascular constrictor, 20-hydroxyeicosatetraenoic acid (20-HETE) in aSAH pathogenesis, yet the translational relevance of 20-HETE in patients with aSAH is largely unknown. The goal of this research was to determine the relationship between 20-HETE cerebrospinal fluid (CSF) levels, gene variants in 20-HETE synthesis, and acute/long-term aSAH outcomes. In all, 363 adult patients (age 18 to 75) with aSAH were prospectively recruited from the University of Pittsburgh Medical Center neurovascular Intensive Care Unit. Patients were genotyped for polymorphic variants and cytochrome P450 (CYP)-eicosanoid CSF levels were measured over 14 days. Outcomes included delayed cerebral ischemia (DCI), clinical neurologic deterioration (CND), and modified Rankin Scores (MRS) at 3 and 12 months. Patients with CND and unfavorable 3-month MRS had 2.2-and 2.7-fold higher mean 20-HETE CSF levels, respectively. Patients in high/moderate 20-HETE trajectory groups (35.7%) were 2.5-, 2.1-, 3.1-, 3.3-, and 2.1-fold more likely to have unfavorable MRS at 3 months, unfavorable MRS at 12 months, mortality at 3 months, mortality at 12 months, and CND, respectively. These results showed that 20-HETE is associated with acute and long-term outcomes and suggest that 20-HETE may be a novel target in aSAH.

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“…Early brain injury (EBI), which occurs in the acute phase, and delayed cerebral ischemia (DCI) may be primarily involved in such sequelae related to subarachnoid hemorrhage. [3][4][5][6] As the simplest parameter that represents the grade of EBI, the World Federation of Neurological Surgeons (WFNS) grade has been used. A study reported that the outcome was poorer in highergrade patients.…”

Section: Introductionmentioning

confidence: 99%

Current Status of Ruptured Cerebral Aneurysm Treatment in Regional Hospitals and Results of Coil Embolization

Nakatsuka

Terashima

Nishikawa

et al. 2018

NOUSHINKEI KEKKANNAI TIRYOU

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Objective: We examined the current status of ruptured cerebral aneurysm treatment and results of coil embolization in a district. Methods:We conducted a prospective, multicenter, cooperative observational study involving 169 patients with ruptured cerebral aneurysms who were treated in the acute phase between September 2013 and March 2016. Predictive factors for poor outcome (90-day modified Rankin Scale 3-6) were investigated, and the results were compared between craniotomy and coil embolization. Results:Coil embolization was performed for 39 patients (23.1%). In all, 63 (37.3%) patients had poor outcome. Univariate analysis showed that predictive factors for poor outcome included an advanced age, pre-onset disability, history of cerebral infarction, poor grade on admission, modified Fisher grade 4, acute hydrocephalus, cerebrospinal fluid drainage, craniotomy, craniotomy-related complications, the absence of fasudil hydrochloride administration, delayed cerebral ischemia, delayed cerebral infarction, shunting, pneumonia, and heart failure. On multivariate analysis, predictive factors for poor outcome included pre-onset disability, poor grade on admission, modified Fisher grade 4, delayed cerebral infarction, and heart failure, whereas the prophylactic administration of intravenous fasudil hydrochloride and coil embolization were independent factors associated with good outcome. In patients who underwent craniotomy, the incidences of cerebral vasospasm and cerebral infarction were significantly higher than in those who underwent coil embolization. Conclusion:This was an observational study, and the indication of treatment or strategies differed among institutions, which was a limitation. However, coil embolization was an independent factor associated with good outcome.Keywords▶ subarachnoid hemorrhage, outcome, prognostic factor, endovascular therapy IntroductionRuptured cerebral aneurysm-related subarachnoid hemorrhage is a serious disease, with a high mortality rate. Although there have been no marked changes in its incidence during the past 30 years, the mortality rate has decreased to 1/2. 1,2) This may have been related to advances in diagnostic imaging procedures, such as CT, and treatment, such as clipping and coil embolization. However, there are still many patients complaining of sequelae. Early brain injury (EBI), which occurs in the acute phase, and delayed cerebral ischemia (DCI) may be primarily involved in such sequelae related to subarachnoid hemorrhage. [3][4][5][6] As the simplest parameter that represents the grade of EBI, the World Federation of Neurological Surgeons (WFNS) grade has been used. A study reported that the outcome was poorer in highergrade patients. 7) Various predictive factors for poor outcome have been reported, but most factors are present on admission; there are few factors for which intervention is possible. 8) On the other hand, as a treatment modality, the International Subarachnoid Aneurysm Trial (ISAT) indicated the advantage of coil embolization. 9) However, the Diag...

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Early Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Cited by 95 publications

References 26 publications

The VASOGRADE

The VASOGRADE

20-HETE is Associated with Unfavorable Outcomes in Subarachnoid Hemorrhage Patients

Current Status of Ruptured Cerebral Aneurysm Treatment in Regional Hospitals and Results of Coil Embolization

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