Article
The impact of an elaborated CT-perfusion protocol for acute management of patients with aneurysmal subarachnoid haemorrhage (aSAH) on ischemic complication and functional long-term outcome
Der Einfluss eines CT-Perfusions Protokoll auf das funktionelle Langzeit-Outcome von Patienten mit aneurysmatischer Subarachnoidalblutung und assoziierten ischämischen Komplikationen
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Authors
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Katja Döring
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Dorothee Mielke
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Vesna Malinova
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: The long-term functional outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) depends mainly on the aSAH-severity and the occurrence of early and late ischemic complications in the acute phase after the ictus. Computer tomography perfusion (CTP) has been increasingly implemented in the acute management of aSAH. Despite of increasing evidence supporting the usefulness of CTP in aSAH-patients, its effective impact on functional outcome is still insufficiently evaluated. The aim of this study was to assess the functional outcome in aSAH-patients treated according to an elaborated CTP-protocol compared to patients treated for aSAH before the implementation of the CTP-protocol.
Methods: We performed a retrospective analysis of aSAH-patients treated between 2008 and 2018 (2008-2011 without CTP-protocol and 2012-2018 with CTP-protocol). Demographic and clinical data were extracted from the medical records. The CTP-protocol included a routine CTP on day 3 and day 7 in sedated/comatose patients and in case of clinical deterioration or blood flow acceleration measured by transcranial Doppler sonography over 120 cm/s. The functional outcome was assessed according to the modified Rankin scale (mRS) at least 3 months after ictus, whereas a mRS≤3 was considered as good outcome.
Results: A total of 375 patients were included in the analysis of this study. 95 patients were treated without a CTP-protocol (group 1) and 279 patients with a CTP-protocol (group 2). A good aSAH-grade (Hunt&Hess I-III) was found in 60.6% in group 1 compared to 67.1% in group 2. A good mRS was found in 47.6% in group 1 vs 63.3% in group 2. The mean cumulative radiation exposure (RE) in group 1 was 36.7 mSV compared to 55.4 mSv in group 2.
Conclusion: Patients with aSAH managed according to an elaborated CTP-protocol have better functional outcome compared to patients who were treated without CTP protocol. Due to a higher radiation exposure of a CTP-based protocol the evaluation of equivalent alternative imaging protocols without radiation exposure is necessary in order to reduce the RE in aSAH-patients during the acute phase after the ictus.
