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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Radiological and clinical outcome of patients with subarachnoid hemorrhage after angioplasty for treatment of delayed cerebral ischemia based on a CT perfusion-protocol

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  • Vesna Malinova - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Ioannis Tsogkas - Uni, Institut f. Diagn. und Interv. Neuroradiologie, Abteilung für Neuroradiologie, Göttingen, Deutschland
  • Marios-Nikos Psychogios - University of Goettingen, Abteilung Neuroradiologie, Institut für Diagnostische und Interventionelle Neuroradiologie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.02.04

doi: 10.3205/17dgnc010, urn:nbn:de:0183-17dgnc0109

Published: June 9, 2017

© 2017 Malinova et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Delayed cerebral ischemia (DCI) is a severe complication leading to poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). CT perfusion (CTP) allows the detection of „tissue at risk“ for DCI and might be a helpful diagnostic tool to select patients for endovascular treatment to avoid delayed cerebral infarction. The aim of this study was to evaluate the radiological and clinical outcome of the patients who underwent endovascular intervention based on a CTP-protocol.

Methods: A CTP-protocol consisting of CTP on day 3 after aSAH, CTP in case of increased (>120cm/s) blood-flow-velocity (BFV) measured by transcranial Doppler sonography (TCD), CTP in case of new neurological deficit in awake patients as well as CTP on day 7 in comatose or sedated patients has been applied in our clinic since January 2012. If „tissue at risk“ was identified after qualitative and quantitative evaluation of the CTP an endovascular intervention (angioplasty with or without intraarterial nimodipine application) was performed. The radiological outcome concerning delayed infarction was evaluated based on a CT scan before discharge. The clinical outcome was determined according to the Glasgow outcome score (GOS) and the modified Rankin scale (mRS) six months after discharge.

Results: A total of 203 patients with aSAH were treated according to the CTP-protocol. In 46 of these patients endovascular intervention was performed to treat DCI. 57% of them had an initially good Hunt & Hess grade (1-3) and 94% had a high modified Fisher grade (3-4). Increased BFV was found in 81% (37/46) of the patients (mean BFV right MCA 172cm/s, left MCA 147cm/s). In all but two patients the BFV normalized after the intervention (mean BFV right MCA 99cm/s, left MCA 84cm/s). Delayed infarction occurred in 24% (11/46) of these patients. A good clinical outcome 6 months after the bleeding according to the GOS (3-5) had 80% and according to the mRS (0-3) 74% of the 46 patients.

Conclusion: An elaborated CTP-protocol allows the selection of patients with delayed cerebral ischemia for endovascular treatment, which can reduce the incidence of delayed infarction associated with permanent neurological deficits. Subsequently, it may improve the radiological and clinical outcome of patients suffering from aSAH.