Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Neurosurg Rev. 2024 Sep 7;47(1):564. doi: 10.1007/s10143-024-02795-1.
Delayed cerebral ischemia (DCI) is one of the most important outcome determinants for aneurysmal subarachnoid hemorrhage (aSAH). VASOGRADE, which combines World Federation of Neurological Surgeons grade and modified Fisher grade, is a useful scale for predicting DCI after aSAH. However, no studies have investigated whether VASOGRADE influences the treatment options. We retrospectively analyzed 781 aSAH patients who were prospectively enrolled in 9 primary stroke centers from 2013 to 2021. The total cohort consisted of 76 patients (9.7%) with VASOGRADE-Green, 390 patients (49.9%) with VASOGRADE-Yellow, and 315 patients (40.3%) with VASOGRADE-Red. Worse VASOGRADE had higher incidences of DCI, which occurred in 190 patients (24.3%). As only 5 patients (6.6%) with VASOGRADE-Green developed DCI, we searched for DCI-associated factors in patients with VASOGRADEs-Yellow and -Red. Multivariate analyses revealed independent treatment factors suppressing DCI as follows: no postoperative hemorrhagic complication, combined administration of fasudil hydrochloride and cilostazol, combination of clipping and cisternal drainage, and coiling for VASOGRADE-Yellow; and clipping, and administration of fasudil hydrochloride with or without cilostazol for VASOGRADE-Red. The findings suggest that treatment strategies should be determined based on VASOGRADE to prevent DCI after aSAH.
迟发性脑缺血（DCI）是动脉瘤性蛛网膜下腔出血（aSAH）最重要的预后决定因素之一。VASOGRADE 结合了世界神经外科学会分级和改良 Fisher 分级，是预测 aSAH 后 DCI 的有用量表。然而，尚无研究探讨 VASOGRADE 是否影响治疗选择。我们回顾性分析了 2013 年至 2021 年期间，9 个初级卒中中心前瞻性纳入的 781 例 aSAH 患者。总队列包括 76 例（9.7%）VASOGRADE-Green 级、390 例（49.9%）VASOGRADE-Yellow 级和 315 例（40.3%）VASOGRADE-Red 级患者。VASOGRADE 分级越差，DCI 的发生率越高，共有 190 例（24.3%）患者发生 DCI。由于仅 5 例（6.6%）VASOGRADE-Green 级患者发生 DCI，我们在 VASOGRADEs-Yellow 和 -Red 级患者中寻找与 DCI 相关的因素。多因素分析显示，抑制 DCI 的独立治疗因素如下：无术后出血性并发症、联合使用盐酸法舒地尔和西洛他唑、夹闭联合脑池引流、VASOGRADE-Yellow 级患者血管内治疗；夹闭、联合使用盐酸法舒地尔和/或西洛他唑，VASOGRADE-Red 级患者行血管内治疗。研究结果表明，为预防 aSAH 后 DCI，应根据 VASOGRADE 确定治疗策略。
