Risk Profile of Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Early Perfusion Computed Tomography

Tsuang, Fon-Yih; Chen, Jo-Yu; Lee, Chung-Wei; Li, Chien-Hsun; Lee, Jing Er; Lai, Dar Ming; Hu, Fang; Tu, Yong Kwang; Hsieh, Sung‐Tsang; Wang, Kuo-Chuan

doi:10.1016/j.wneu.2011.12.004

Cited by 19 publications

(12 citation statements)

References 23 publications

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“…In general, previous studies within this context partially support our findings but (1) used heterogeneous definition of early PCT scanning, 12-72 hours after SAH ictus, (2) solely investigated poor grade SAH patients, WFNS IV and V, (3) reported on data derived from smaller patient cohorts and, importantly, (4) did not include clot volume measurements in early radiographic risk prediction. 7,[16][17][18][19] It is known that (1) 10% to 20% of patients may present with early angiographic vasospasm during 24 hours after SAH ictus and (2) poor grade SAH is strongly associated with poor outcome, per se. 2,20 However, such studies should particularly address the early and more sensitive identification of those patients with SAH, with initial good clinical grades, who are at increased risk for subsequent DCI and poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Early Perfusion Computerized Tomography Imaging as a Radiographic Surrogate for Delayed Cerebral Ischemia and Functional Outcome After Subarachnoid Hemorrhage

Etminan

Beseoglu

Heiroth

et al. 2013

Stroke

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Background and Purpose-To date, there is no immediate radiographic surrogate to quantify primary cerebral injury to identify patients at risk for delayed cerebral ischemia and poor clinical outcome after aneurysmal subarachnoid hemorrhage. Therefore, we investigated the relation of early cerebral perfusion-computerized tomography and clot volume with radiological events of delayed cerebral ischemia and clinical outcome in patients with aneurysmal subarachnoid hemorrhage. Methods-Data from 2 cohorts of patients (51 in main, 28 patients in control cohort) with aneurysmal subarachnoid hemorrhage, receiving computerized tomography and perfusion-computerized tomography scanning <12 hours after ictus, were included. A risk group model for functional outcome was developed on the basis of early mean transit time (MTT) and volumetric blood clot measurements.

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Section: Discussionmentioning

confidence: 99%

Early Perfusion Computerized Tomography Imaging as a Radiographic Surrogate for Delayed Cerebral Ischemia and Functional Outcome After Subarachnoid Hemorrhage

Etminan

Beseoglu

Heiroth

et al. 2013

Stroke

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“…Moreover, there is increasing evidence in the literature on the diagnostic value of perfusion CT imaging in the management of DCI [25,26]. However, this diagnostic modality has not been used in our clinic in the described observational period.…”

Section: Discussionmentioning

confidence: 99%

Early Vasospasm after Aneurysmal Subarachnoid Hemorrhage Predicts the Occurrence and Severity of Symptomatic Vasospasm and Delayed Cerebral Ischemia

Jabbarli¹,

Reinhard²,

Shah³

et al. 2016

Cerebrovasc Dis

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Background: Cerebral vasospasm usually develops several days after subarachnoid hemorrhage (SAH) and is generally acknowledged as a strong outcome predictor. In contrast, much less is known about the nature and eventual consequences of early angiographic vasospasm (EAVS) seen on admission digital subtraction angiography (DSA). Therefore, we aimed at identifying the risk factors and clinical impact of EAVS after SAH. Methods: Five hundred and thirty-one SAH patients with admission DSA performed within 72 h after the bleeding event were selected from a comprehensive database containing all consecutive SAH patients treated at our institution between January 2005 and December 2012. Predictors of EAVS, as well as associations between EAVS and delayed vasospasm-related complications, and unfavorable outcome (defined as modified Rankin scale >3) were evaluated in univariate and multivariate analyses. Results: EAVS was seen on 60 DSAs (11.3%) and was independently correlated with delayed symptomatic vasospasm requiring intra-arterial spasmolysis (OR 5.24, p < 0.0001), angioplasty (OR 2.56, p = 0.015) and repetitive endovascular treatment (OR 4.71, p < 0.0001). EAVS also increased the risk for multiple versus single territorial infarction on the follow-up CT scan(s) (OR 2.04, p = 0.047) and independently predicted unfavorable outcome (OR 2.93, p = 0.008). The presence of radiographic signs suspicious for fibromuscular dysplasia were independently associated with the occurrence of EAVS (OR 2.98, p = 0.026) and the need for repetitive endovascular vasospasm treatment (OR 3.95, p = 0.019). Conclusions: In view of the strong correlation with delayed symptomatic vasospasm and its ischemic complications, EAVS can be considered an alerting signal for severe symptomatic vasospasm. Therefore, more attention should be paid to the presence of EAVS on admission DSA.

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“…However, they did not find an early peak of mean MTT values within the first days. Previous studies highlighted that deterioration of CT perfusion parameters in the early phase after SAH ictus may be predictive for the occurrence of DCI and poor neurological outcome [4,[19][20][21]. However, these studies solely analyzed CTP evaluations within the first few days after SAH onset (usually within the first 4 days), irrespective of subsequent imaging.…”

Section: Resultsmentioning

confidence: 99%

Timing of Mean Transit Time Maximization is Associated with Neurological Outcome After Subarachnoid Hemorrhage

et al. 2015

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Risk Profile of Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Early Perfusion Computed Tomography

Cited by 19 publications

References 23 publications

Early Perfusion Computerized Tomography Imaging as a Radiographic Surrogate for Delayed Cerebral Ischemia and Functional Outcome After Subarachnoid Hemorrhage

Early Perfusion Computerized Tomography Imaging as a Radiographic Surrogate for Delayed Cerebral Ischemia and Functional Outcome After Subarachnoid Hemorrhage

Early Vasospasm after Aneurysmal Subarachnoid Hemorrhage Predicts the Occurrence and Severity of Symptomatic Vasospasm and Delayed Cerebral Ischemia

Timing of Mean Transit Time Maximization is Associated with Neurological Outcome After Subarachnoid Hemorrhage

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