Association of a younger age with an increased risk of angiographic and symptomatic vasospasms following subarachnoid hemorrhage

Magge, Suresh N.; Chen, H Isaac; Ramakrishna, Rohan; Cen, Liyi; Chen, Zhe; Elliott, Joseph P.; Winn, H. Richard; Roux, Peter D. Le

doi:10.3171/2009.9.jns081670

Cited by 35 publications

(19 citation statements)

References 49 publications

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“…This relatively high rate of angiographic CV is likely due to the high vasoreactivity of the vessels in young individuals. In contrast, as explained by Magge et al, 29 the increased stiffness of the cerebral vasculature associated with advanced age may explain the lower prevalence of angiographic CV in the population of older adults. Postmortem studies in humans have indicated that aging leads to an increased accumulation of collagen in the vessel wall, along with intimal thickening and fibrosis.…”

Section: Discussioncontrasting

confidence: 45%

“…For example, Yoshimoto and Kwak 49 and Macdonald et al, 28 who used DSA to diagnose CV, observed that a younger age is associated with a greater frequency of severe angiographic CV. Magge et al 29 also reported that the likelihood of severe vasospasm was greater with a younger age; patients with severe angiographic CV were on average 9 years younger than those with no CV. Again, this is likely attributable to the relatively increased vasoreactivity at younger ages.…”

Section: Discussionmentioning

confidence: 95%

“…Some studies have suggested that younger adults have a higher risk for developing CV. 28,29,49 There is no clear consensus, in part because CV can be diagnosed with different modalities and approaches, including digital subtraction angiography (DSA), CT angiography, transcranial Doppler (TCD) ultrasonography, and evaluation of clinical symptoms. The few published studies on CV in children have concluded that this group has a relatively high rate of CV diagnosed by angiography.…”

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confidence: 99%

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Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

Moftakhar

Cooke

Fullerton

et al. 2015

PED

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OBJECT Although the development and prevalence of cerebral vasospasm (CV) has been extensively investigated in adults, little data exist on the development of CV in children. The authors hypothesized that even though children have highly vasoreactive arteries, because of a robust cerebral collateral blood flow, they rarely develop symptomatic CV. METHODS The authors retrospectively reviewed their university hospital's neurointerventional database for children (that is, patients ≤ 18 years) who were examined or treated for aneurysmal or traumatic subarachnoid hemorrhage (SAH) during the period 1990–2013. Images from digital subtraction angiography (DSA) were analyzed for the extent of CV and collateralization of the cerebral circulation. Results from transcranial Doppler (TCD) ultrasonography were correlated with those from DSA. Cerebral vasospasm on TCD ultrasonography was defined according to criteria developed for adults. Clinical outcomes of CV were assessed with the pediatric modified Rankin Scale (mRS). RESULTS Among 37 children (21 boys and 16 girls ranging in age from 8 months to 18 years) showing symptoms of an aneurysmal SAH (comprising 32 aneurysms and 5 traumatic pseudoaneurysms), 17 (46%) had CV confirmed by DSA; CV was mild in 21% of these children, moderate in 50%, and severe in 29%. Only 3 children exhibited symptomatic CV, all of whom had poor collateralization of cerebral vessels. Among the 14 asymptomatic children, 10 (71%) showed some degree of vessel collateralization. Among 16 children for whom TCD data were available that could be correlated with the DSA findings, 13 (81%) had CV according to TCD criteria. The sensitivity and specificity of TCD ultrasonography for diagnosing CV were 95% and 59%, respectively. The time to CV onset detected by TCD ultrasonography was 5 ± 3 days (range 2–10 days). Twenty-five (68%) of the children had good long-term outcomes (that is, had mRS scores of 0–2). CONCLUSIONS Children have a relatively high incidence of angiographically detectable, moderate-to-severe CV. Children rarely develop symptomatic CV and have good long-term outcomes, perhaps due to robust cerebral collateral blood flow. Criteria developed for detecting CV with TCD ultrasonography in adults overestimate the prevalence of CV in children. Larger studies are needed to define TCD ultrasonography–based CV criteria for children.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 95%

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confidence: 99%

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Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

Moftakhar

Cooke

Fullerton

et al. 2015

PED

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“…10 Age, the third main independent factor for the development of DCI, was left out of our grading system. Although age is well described as an independent predictor of outcome and advanced age has been consistently associated with lower incidence of angiographic vasospasm and DCI, 16,[30][31][32][33] aging is inversely related to favorable outcomes. 3 Older age is associated with larger subarachnoid clot volume, 34 and elderly patients (>60 years) have significant increased risk of poor outcome 3 because of higher rates of medical complications, 32,35 the main reason age was not included in our grading scale.…”

Section: 11mentioning

confidence: 99%

The VASOGRADE

Manoel¹,

Jaja

Germans³

et al. 2015

Stroke

103

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Background and Purpose— Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale—the VASOGRADE—for prediction of DCI. Methods— We used data of 3 phase II randomized clinical trials and a single hospital series to assess the relationship between the VASOGRADE and DCI. The VASOGRADE derived from previously published risk charts and consists of 3 categories: VASOGRADE-Green (modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale [WFNS] 1 or 2); VASOGRADE-Yellow (modified Fisher 3 or 4 and WFNS 1–3); and VASOGRADE-Red (WFNS 4 or 5, irrespective of modified Fisher grade). The relation between the VASOGRADE and DCI was assessed by logistic regression models. The predictive accuracy of the VASOGRADE was assessed by receiver operating characteristics curve and calibration plots. Results— In a cohort of 746 patients, the VASOGRADE significantly predicted DCI ( P <0.001). The VASOGRADE-Yellow had a tendency for increased risk for DCI (odds ratio [OR], 1.31; 95% CI, 0.77–2.23) when compared with VASOGRADE-Green; those with VASOGRADE-Red had a 3-fold higher risk of DCI (OR, 3.19; 95% CI, 2.07–4.50). Studies were not a significant confounding factor between the VASOGRADE and DCI. The VASOGRADE had an adequate discrimination for prediction of DCI (area under the receiver operating characteristics curve=0.63) and good calibration. Conclusions— The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients, which allows DCI risk stratification on presentation after subarachnoid hemorrhage. It could help to select patients at high risk of DCI, as well as standardize treatment protocols and research studies.

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“…10) Recent reports of predictors of vasospasm are shown in Table 2. 3,8,10,11,19,22,29,30,34) In addition, studies have used near-infrared spectroscopy, xenon CT, perfusion CT, and probability index, but many of these methods are detectors of vasospasm, not predictors of vasospasm. These reports showed no clear threshold.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Cerebral Vasospasm Using Early Stage Transcranial Doppler

Toi

Matsumoto

Yokosuka

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Transcranial Doppler (TCD) is widely used to monitor vasospasm after subarachnoid hemorrhage (SAH), but its ability to predict the future occurrence of the symptomatic vasospasm (SVS) remains controversial. We investigated the utility of TCD for predicting the future occurrence of SVS after SAH in 45 patients with aneurysmal SAH. TCD was performed on days 1, 3, 5, 7, 10, and 14 after SAH. The mean flow velocity (MFV) of the horizontal portion of the middle cerebral artery (M 1 ) was recorded. SVS occurred in 24.4% of patients (n ＝ 11). MFV of M 1 increased progressively in patients with SVS, but did not increase in patients without SVS. The mean MFV values were significantly higher in patients with SVS than in patients without SVS (p ＝ 0.031). The mean MFV value on day 3 was already significantly higher in patients with SVS than in patients without SVS (88.5 cm/sec versus 62.7 cm/sec, respectively) (p ＝ 0.018). The receiver operating characteristic curve of MFV on day 3 showed the threshold of 72.5 cm/sec for predictive value of SVS in the future (sensitivity 71.4%, specificity 68.1%, and accuracy 82.3%). Increased MFV of M 1 during the early stage of SAH may predict the future occurrence of SVS. The threshold value of 72.5 cm/sec MFV of M 1 on SAH day 3 was one of the best predictor of future SVS. To prevent delayed cerebral ischemia, aggressive treatment for vasospasm is needed for patients with increased MFV in the early stages of SAH.

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Association of a younger age with an increased risk of angiographic and symptomatic vasospasms following subarachnoid hemorrhage

Abstract: Results in this study show that a younger age is associated with an increased incidence of angiographic and symptomatic vasospasm.

Cited by 35 publications

References 49 publications

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

The VASOGRADE

Prediction of Cerebral Vasospasm Using Early Stage Transcranial Doppler

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