Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Neurol. 2022 Feb;29(2):620-625. doi: 10.1111/ene.15139. Epub 2021 Nov 7.
Delayed cerebral ischaemia (DCI) is a severe complication of aneurysmal subarachnoid hemorrhage that can significantly impact clinical outcome. Cerebral vasospasm is part of the pathophysiology of DCI and therefore a computed tomography angiography (CTA) Vasospasm Score was developed and an exploration was carried out of whether this score predicts DCI and subsequent poor outcome after aneurysmal subarachnoid hemorrhage.
The CTA Vasospasm Score sums the degree of angiographic cerebral vasospasm of 17 intradural arterial segments. The score ranges from 0 to 34 with a higher score reflecting more severe vasospasm. Outcome measures were cerebral infarction due to DCI (CI-DCI), radiological and clinical DCI, and unfavorable functional outcome defined as a modified Rankin Scale >2 at 6 months. Receiver operating characteristic analyses were used to assess predictive value and to determine optimal cut-off scores. Inter-rater reliability was evaluated by Cohen's kappa coefficient.
This study included 59 patients. CI-DCI occurred in eight patients (14%), DCI in 14 patients (24%) and unfavorable outcome in 12 patients (20%). Median CTA Vasospasm Scores were higher in patients with (CI-)DCI and poor outcome. Receiver operating characteristic analysis revealed the highest area under the curve on day 5: CI-DCI 0.89 (95% confidence interval [CI] 0.79-0.99), DCI 0.68 (95% CI 0.50-0.87) and functional outcome 0.74 (95% CI 0.57-0.91). Cohen's kappa between the two raters was moderate to substantial (0.57-0.63).
This study demonstrates that the CTA Vasospasm Score on day 5 can reliably identify patients with a high risk of developing (CI-)DCI and unfavorable outcome.
迟发性脑缺血（DCI）是颅内动脉瘤性蛛网膜下腔出血的严重并发症，可显著影响临床结局。脑血管痉挛是 DCI 病理生理学的一部分，因此开发了一种计算机断层血管造影（CTA）血管痉挛评分，并对该评分是否能预测 DCI 及随后的颅内动脉瘤性蛛网膜下腔出血不良结局进行了探索。
CTA 血管痉挛评分对 17 个硬脑膜内动脉节段的血管造影脑血管痉挛程度进行评分。评分范围为 0 至 34，分数越高表明血管痉挛越严重。结局测量指标包括因 DCI 导致的脑梗死（CI-DCI）、影像学和临床 DCI 以及 6 个月时改良 Rankin 量表评分>2 的不良功能结局。采用受试者工作特征分析评估预测价值，并确定最佳截断分数。采用 Cohen's kappa 系数评估组间可靠性。
本研究纳入 59 例患者。8 例患者（14%）发生 CI-DCI，14 例患者（24%）发生 DCI，12 例患者（20%）发生不良结局。（CI-）DCI 和不良结局患者的 CTA 血管痉挛评分中位数较高。受试者工作特征分析显示第 5 天的曲线下面积最高：CI-DCI 为 0.89（95%置信区间 [CI] 0.79-0.99），DCI 为 0.68（95% CI 0.50-0.87），功能结局为 0.74（95% CI 0.57-0.91）。两名评分者之间的 Cohen's kappa 值为中等至较大（0.57-0.63）。
本研究表明，第 5 天的 CTA 血管痉挛评分能够可靠地识别出发生（CI-）DCI 和不良结局风险较高的患者。
