Artikel
Which factors predict the discrepancy between delayed cerebral ischemia in the broader sense and imaging-proven infarcts after subarachnoid hemorrhage?
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Autoren
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Bawarjan Schatlo
- Universitätsklinik Göttingen, Klinik f. Neurochirurgie, Göttingen, Deutschland
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Ali-Reza Fathi
- Hirslanden Klinik Aarau, Aarau, Switzerland
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Martin N. Stienen
- Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Switzerland
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Christian Fung
- Inselspital Universität Bern, Klinik für Neurochirurgie, Bern, Switzerland
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Daniel Zumofen
- Basel, Switzerland
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
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Astrid Weyerbrock
- Kantonsspital St. Gallen, Klinik für Neurochirurgie, St. Gallen, Switzerland
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Jan-Karl Burkhardt
- Zürich, Switzerland
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Philippe Bijlenga
- Neurochirurgie, Dpt de Neurosciences cliniques, Genf, Switzerland
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Karl Schaller
- Hôpitaux Universitaires de Genève, Neurochirurgie, Genève, Switzerland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: A recent consensus paper on the term delayed cerebral ischemia (DCI) suggested to include clinical and imaging parameters into its definition. DCI may well be a temporary phenomenon since clinical changes lasting longer than an hour already qualify for the use of the term. In consequence, not all patients with DCI necessarily develop cerebral infarcts. Predictive factors could help identify patients who may benefit from advanced neuromonitoring. The goal of the present analysis is to identify factors separating patients who suffer from DCI resulting in infarcts from those without imaging evidence of brain ischemia and DCI.
Methods: The Swiss study on subarachnoid hemorrhage (Swiss SOS) includes all patients treated for SAH since 1st of January 2009 in all eight neurovascular centers in Switzerland. Data collection includes delayed ischemic neurological deficits and infarcts not related to aneurysm-securing treatment. Multivariate binary regression analysis was used to assess which factors are predictive of an infarct after delayed cerebral ischemia.
Results: 1087 datasets matched the inclusion criteria for the current analysis. DIND/DCI occurred in 310 patients (28.6%). Imaging-proven infarcts not related to aneurysm-securing treatment were present in 185 patients (17.0%). In the group of patients with DCI and cerebral infarcts, 61/152 patients (40.1%) had evidence of treatment-related ischemia. In the group of patients with DCI but without infarcts, this figure was lower 53/158 (33.5%; p=0.026). However, the significance of this finding abated after multivariate analysis (OR 0.63 CI95% [0.38-1.04]; p=0.069). Male sex (OR 0.79 CI95% [0.47-1.31]; p=0.35), high WFNS (OR 0.84 CI95% [0.52-1.35]; p=0.46), high Fisher grade (OR 1.45 CI95% [0.43-4.88]; p=0.55), age>65 years (OR 1.07 CI95% [0.59-1.95]; p=0.82), location of the aneurysm in the anterior circulation (OR 1.39 CI 95% [0.67-2.91]; p=0.37), surgical aneurysm occlusion (OR 1.07 CI95% [0.65-1.76]; p=0.79) and interventional spasmolysis (OR 1.06 CI95% [0.65-1.73]; p=0.83) were not associated with the absence of infarct despite DCI.
Conclusion: Peri-interventional ischemia after aneurysm-securing treatment shows a trend towards a correlation with DCI-associated infarcts. Patients suffering early “hits” early in the course of their SAH may be predisposed to increased vulnerability to “delayed hits”, warranting an increased vigilance in this subgroup.
