Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, 5021 Bergen, Norway.
Department of Global Public Health and Primary Health Care, University of Bergen, 5020 Bergen, Norway.
J Neurol Sci. 2019 Dec 15;407:116539. doi: 10.1016/j.jns.2019.116539. Epub 2019 Oct 17.
Delayed cerebral ischemia (DCI) is a major cause of disability and death after aneurysmal subarachnoid hemorrhage. The literature suggests that impaired cerebrovascular reactivity (CVR) may be a predictor for DCI; still no CVR based prediction model has been developed. Increased knowledge about possible predictors of DCI can improve patient management in high-risk patients and allow for shorter hospital stay in low-risk patients.
CVR was examined in 42 patients with aneurysmal subarachnoid hemorrhage and 37 patients treated for unruptured intracranial aneurysm, using acetazolamide test with transcranial Doppler monitoring of blood flow velocities. Patients were followed for development of DCI, separated into clinical deterioration and radiographic infarction.
For all patients, regardless of aneurysm rupture status, CVR was on average 5.5 percentage points lower on the ipsilateral side of aneurysm treatment. Patients with clinical deterioration due to DCI had lower CVR than patients without DCI, and the difference was larger on the contralateral side (33.9% vs. 49.2%). Two prediction models were constructed for clinical deterioration due to DCI. The area under the receiver operating characteristic curve was 0.82 in the model using established predictors, and 0.86 in the model that also included CVR.
Our findings support the hypothesis that impaired CVR may be an independent predictor of clinical deterioration due to DCI, and may assist in identifying patients at risk after aneurysmal subarachnoid hemorrhage. Ipsilateral CVR reduction occurs in all patients after aneurysm treatment, regardless of DCI development, thus highlighting the need to evaluate ipsi- and contralateral CVR separately.
迟发性脑缺血（DCI）是蛛网膜下腔出血后残疾和死亡的主要原因。文献表明，脑血管反应性（CVR）受损可能是 DCI 的预测指标；但仍未开发出基于 CVR 的预测模型。增加对 DCI 可能预测因素的了解可以改善高危患者的治疗管理，并使低危患者的住院时间缩短。
使用乙酰唑胺试验和经颅多普勒监测血流速度，检查了 42 例蛛网膜下腔出血患者和 37 例未破裂颅内动脉瘤患者的 CVR。将患者分为因 DCI 导致的临床恶化和影像学梗死两组，进行 DCI 发展的随访。
对于所有患者，无论动脉瘤破裂状态如何，在接受动脉瘤治疗的同侧，CVR 平均降低了 5.5 个百分点。因 DCI 导致临床恶化的患者的 CVR 低于无 DCI 的患者，且差异在对侧更大（33.9%对 49.2%）。为因 DCI 导致的临床恶化构建了两个预测模型。使用既定预测因素的模型的受试者工作特征曲线下面积为 0.82，而包括 CVR 的模型为 0.86。
我们的研究结果支持这样一种假设，即 CVR 受损可能是因 DCI 导致的临床恶化的独立预测因素，这可能有助于识别蛛网膜下腔出血后的高危患者。无论是否发生 DCI，在接受动脉瘤治疗后，所有患者的同侧 CVR 均会降低，因此需要分别评估同侧和对侧的 CVR。
