From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany.
Neurology. 2024 Aug 13;103(3):e209607. doi: 10.1212/WNL.0000000000209607. Epub 2024 Jul 1.
Delayed cerebral ischemia (DCI) is one of the main contributing factors to poor clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). Unsuccessful treatment can cause irreversible brain injury in the form of DCI-related infarction. We aimed to assess the association between the location, distribution, and size of DCI-related infarction in relation to clinical outcome.
Consecutive patients with SAH treated at 2 university hospitals between 2014 and 2019 (Helsinki, Finland) and between 2006 and 2020 (Aachen, Germany) were included. Size of DCI-related infarction was quantitatively measured as absolute volume (in milliliters). In a semiquantitative fashion, infarction in 14 regions of interest (ROIs) according to a modified Alberta Stroke Program Early CT Score (ASPECTS) was noted. The association of infarction in these ROIs along predefined regions of eloquent brain, with clinical outcome, was assessed. For this purpose, 1-year outcome was measured by the Glasgow Outcome Scale (GOS) and dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3).
Of 1,190 consecutive patients with SAH, 155 (13%) developed DCI-related infarction. One-year outcome data were available for 148 (96%) patients. A median overall infarct volume of 103 mL (interquartile range 31-237) was measured. DCI-related infarction was significantly associated with 1-year unfavorable outcome (odds ratio [OR] 4.89, 95% CI 3.36-7.34, < 0.001). In patients with 1-year unfavorable outcome, vascular territories more frequently affected were left middle cerebral artery (affected in 49% of patients with unfavorable outcome vs in 30% of patients with favorable outcome; = 0.029), as well as left (44% vs 18%; = 0.003) and right (52% vs 14%; < 0.001) anterior cerebral artery supply areas. According to the ASPECTS model, the right M3 (OR 8.52, 95% CI 1.41-51.34, = 0.013) and right A2 (OR 7.84, 95% CI 1.97-31.15, = 0.003) regions were independently associated with unfavorable outcome.
DCI-related infarction was associated with a 5-fold increase in the odds of unfavorable outcome, after 1 year. Ischemic lesions in specific anatomical regions are more likely to contribute to unfavorable outcome.
Data collection in Aachen was registered in the German Clinical Trial Register (DRKS00030505); on January 3, 2023.
迟发性脑缺血（DCI）是蛛网膜下腔出血（SAH）后临床预后不良的主要因素之一。治疗失败可导致以 DCI 相关梗死形式出现的不可逆脑损伤。我们旨在评估 DCI 相关梗死的位置、分布和大小与临床结局之间的相关性。
连续纳入 2014 年至 2019 年（芬兰赫尔辛基）和 2006 年至 2020 年（德国亚琛）在 2 所大学医院接受治疗的连续 SAH 患者。DCI 相关梗死的大小通过绝对体积（毫升）进行定量测量。采用改良的阿尔伯塔卒中项目早期 CT 评分（ASPECTS）中的 14 个感兴趣区（ROI）对梗死进行半定量评估。评估这些 ROI 中与预设的语言相关脑区之间的梗死与临床结局的关系。为此，采用格拉斯哥结局量表（GOS）对 1 年结局进行测量，并分为有利（GOS 4-5）和不利（GOS 1-3）。
在 1190 例连续的 SAH 患者中，155 例（13%）发生 DCI 相关梗死。148 例（96%）患者可获得 1 年的结局数据。测量的总体梗死体积中位数为 103 毫升（四分位距 31-237）。DCI 相关梗死与 1 年不良结局显著相关（优势比 [OR] 4.89，95%CI 3.36-7.34，<0.001）。在 1 年结局不良的患者中，血管受累区域更常见为左侧大脑中动脉（不良结局患者中受累 49%，有利结局患者中受累 30%； = 0.029），左侧（44%比 18%； = 0.003）和右侧（52%比 14%；<0.001）前循环供应区。根据 ASPECTS 模型，右侧 M3（OR 8.52，95%CI 1.41-51.34， = 0.013）和右侧 A2（OR 7.84，95%CI 1.97-31.15， = 0.003）区域与不良结局独立相关。
DCI 相关梗死与 1 年后不良结局的可能性增加了 5 倍。特定解剖区域的缺血性病变更有可能导致不良结局。
亚琛的数据收集在德国临床试验注册处（DRKS00030505）进行注册；于 2023 年 1 月 3 日。
