Department of Neuroradiology, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
Neuroradiology. 2021 Dec;63(12):2131-2138. doi: 10.1007/s00234-021-02749-0. Epub 2021 Jul 14.
Delayed cerebral ischemia (DCI) remains a contributor to poor outcome following aneurysmal subarachnoid hemorrhage (aSAH). We evaluated cerebral circulation time (CCT) on digital subtraction angiography (DSA) during endovascular treatment (EVT) in WFNS grade I aSAH patients as a predictor of DCI.
Of 135 consecutive WNFS grade I aSAH patients, 90 were included. Age, gender, time of DSA from ictus (< 72 h or > 72 h), Fisher scale, severe vasospasm, development of DCI, EVD-dependent hydrocephalus, re-bleeding, and procedural complications were recorded. CCT was calculated retrospectively from multiphase DSA. Association with DCI was established through univariate and, subsequently, multivariable logistic regression. An optimal threshold value was identified using ROC curve analysis. Patient groups defined by threshold CCT value, DCI, and, subsequently, time of DSA from ictus were analyzed using χ and Fisher's exact test.
CCT was the only significant factor in the multivariable logistic regression for the outcome development of DCI (OR/second increase in CCT = 1.46 [95% CI 1.14-1.86, p = .003]). When CCT was dichotomized at 8.5 s, the odds ratio for developing DCI was 7.12 (95% CI 1.93-26.34, p = .003) for CCT > 8.5 s compared with < 8.5 s. There was a significant difference for DCI in all patient groups dichotomized by CCT < 8.5 s and > 8.5 s (all patients, p = .001; patients imaged before and after 72 h of ictus, p = .024 and p = .034, respectively).
A CCT > 8.5 s on DSA during EVT in WFNS grade I aSAH patients is associated with an increased risk of developing DCI and may aid in the management of high-risk patients.
迟发性脑缺血（DCI）仍然是蛛网膜下腔出血（aSAH）后预后不良的原因。我们评估了 WFNS 分级 I 级 aSAH 患者血管内治疗（EVT）期间数字减影血管造影（DSA）的脑循环时间（CCT）作为 DCI 的预测因子。
连续纳入 135 例 WFNS 分级 I 级 aSAH 患者，其中 90 例纳入本研究。记录年龄、性别、DSA 从发病到（<72 小时或>72 小时）、Fisher 分级、严重血管痉挛、DCI 发展、EVD 依赖性脑积水、再出血和程序并发症。CCT 从多期 DSA 中回顾性计算。通过单变量和随后的多变量逻辑回归确定与 DCI 的关联。通过 ROC 曲线分析确定最佳阈值。使用 χ 和 Fisher 精确检验分析根据阈值 CCT 值、DCI 和随后的发病到 DSA 时间定义的患者组。
在多变量逻辑回归中，CCT 是 DCI 发生结局的唯一显著因素（OR/第二增加的 CCT = 1.46 [95% CI 1.14-1.86，p = 0.003]）。当 CCT 在 8.5 秒处二分时，与<8.5 秒相比，CCT>8.5 秒时发生 DCI 的优势比为 7.12（95% CI 1.93-26.34，p = 0.003）。所有根据 CCT<8.5 秒和>8.5 秒分组的患者组在 DCI 方面均存在显著差异（所有患者，p=0.001；72 小时内和 72 小时后进行影像学检查的患者，p=0.024 和 p=0.034）。
WFNS 分级 I 级 aSAH 患者 EVT 期间 DSA 上的 CCT>8.5 秒与发生 DCI 的风险增加相关，可能有助于高危患者的管理。
