Artikel
Computed tomography angiography spot sign as a predictor for outcome for patients with intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage
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Autoren
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Jan-Karl Burkhardt
- Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
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Marian Neidert
- Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
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Martin Nikolaus Stienen
- Klinik für Neurochirurgie, Kantonsspital St.Gallen, St.Gallen, Schweiz; Klinik für Neurochirurgie, Hospitaux Universitaires de Geneve (HUG), Geneva, Schweiz
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Daniel Schöni
- Klinik für Neurochirurgie, Inselspital Bern, Bern, Schweiz
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Christian Fung
- Klinik für Neurochirurgie, Inselspital Bern, Bern, Schweiz
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Michel Röthlisberger
- Klinik für Neurochirurgie, Universitätsspital Basel, Basel, Schweiz
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Marco Corniola
- Klinik für Neurochirurgie, Hospitaux Universitaires de Geneve (HUG), Geneva, Schweiz
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David Bervini
- Klinik für Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Schweiz
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Rudolfo Maduri
- Klinik für Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Schweiz
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Daniele Valsecchi
- Klinik für Neurochirurgie, Ospedale Regionale di Lugano, Lugano, Schweiz
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Sina Tok
- Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
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Bawarjan Schatlo
- Klinik für Neurochirurgie, Universitätsklinik Göttingen, Göttingen, Deutschland
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Karl Schaller
- Klinik für Neurochirurgie, Hospitaux Universitaires de Geneve (HUG), Geneva, Schweiz
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Luca Regli
- Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
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Oliver Bozinov on behalf of the Swiss SOS study group
- Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: To analyze the use of computed tomography angiography (CTA) spot sign to predict outcome in intracerebral hemorrhage (ICH) patients with aneurysmal subarachnoid hemorrhage (aSAH) from a nationwide SAH registry.
Method: All patient data was obtained from the nationwide multicentre registry database, at time of analysis covering 1570 patients treated for aneurysmal subarachnoid haemorrhage (aSAH). Complete data set from 1023 patients were available including baseline characteristic, radiographic aneurysmal and ICH characteristics including spot sign, treatment and admission course as well as outcome at discharge and 1 year follow-up using modified Rankin Scale for descriptive and univariate statistics.
Results: From a total of 1023 aSAH patients 218 patients (21%) presented with ICH including 23/218 (11%) patients with spot sign. Age, gender, BMI and tobacco use was comparable between all groups. There was a higher clip to coil ratio in patients with ICH (with and without spot sign) than non-ICH patients. Baseline median ICH volume was significantly higher in the spot sign ICH group (50mL, 12-209mL) than in the non-spot sign ICH group (18mL, 0-416) (p<0.0001). Intraprocedural aneurysm rupture was significantly higher in the spot sign than in the non-spot sign group (p=0.46). Both in hospital death (HD) and death at 1 year at follow-up (1YD) were significantly higher (p<0.0001) and dichotomized mRS outcome (0-2 vs 3-6) at discharge (mRSD) and 1 year follow-up (mRS1Y) were significantly worse (p<0.0001) in patients with ICH (median mRS 4) compared to patients without ICH (median mRS 2), respectively. Spot sign positive ICH patients showed a worse mRSD (p=0.039) than patients with spot sign negative ICH patients (median mRS 5 vs 4). Both groups showed comparable HD, 1YD and mRS1Y.
Conclusions: In this multicenter data analysis patients with spot sign positive ICH showed a higher baseline ICH volume, higher intraprocedural aneurysm rupture and a worse dichotomized mRS at discharge compared to spot sign negative ICH patients. At 1 year follow-up clinical outcome and death rate were comparable between both groups.
