Artikel
Diagnosis of delayed cerebral ischemia by routine volume CT perfusion in patients with high-grade aneurysmal subarachnoid hemorrhage: a prospective study
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Juni 2016 |
---|
Gliederung
Text
Objective: The early diagnosis of delayed cerebral ischemia (DCI) in patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) is challenging. DCIs can be missed because the high SAH grade with patients being intubated and sedated does not allow neurological assessment. Routine application of diagnostic techniques are necessary to detect DCI early enough to initiate therapeutic measures. The aim of this prospective study was to evaluate the diagnostic value of routinely performed volume CT perfusion (CTP) for the diagnosis of DCI in patients with high-grade aSAH.
Method: Volume CTP was routinely on day 7 (the assumed day of highest cerebral vasospasm incidence) in patients with high-grade aSAH. Qualitative and quantitative analysis of the CTP parameters was performed. Primary endpoint was the development of DCI within 14 days after aSAH. DCI was defined as the occurrence of delayed infarction between day 5-14 after aSAH, after exclusion of infarction associated with aneurysm treatment.
Results: Twenty-eight patients with high grade aSAH were prospectively included in the study. The mean age was 54.8 years (range 29-78). DCI occurred in 57% (16/28) of all patients. Perfusion deficits on day 7 were found in 65% (18/28) of the patients and in 56% (10/18) DCI developed. The detection of perfusion deficits by CTP on day 7 was statistically significant associated with the development of DCI (Fisher’s Exact test p=0.005). In four of these patients an endovascular intervention was performed on day 7 as a consequence of the CTP findings. In two of them the occurrence of infarction with permanent neurological deficits could be prevented.
Conclusions: The results of this prospective study are supporting the diagnostic value of routine CTP measurements in patients with high-grade aSAH for the detection of DCI. Nevertheless the CTP on day 7 couldn’t prevent the occurrence of infarction in all patients. A CTP timepoint before the vasospasm peak might allow an earlier initiation of treatment measures in order to avoid delayed infarctions.