Clot volume and clearance rate as independent predictors of vasospasm after aneurysmal subarachnoid hemorrhage

Reilly, Christopher; Amidei, Chris; Tolentino, Jocelyn; Jahromi, Babak S.; Macdonald, R. Loch

doi:10.3171/jns.2004.101.2.0255

Cited by 167 publications

(103 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6,56 There are independent correlations among the location, volume, duration of presence, and density (another measure of clot dose) of the hematoma and angiographic vasospasm. 16,17,46,56 Furthermore, removing the clot in humans prevents vasospasm. 14,62 Even though these data are not perfect, because the information has one or more flaws, including retrospective assessment, lack of blinding, small patient numbers, no statistical analysis, and no qualitative end points, clinical experience still is important and the basic premise is hard to deny.…”

Section: Does Sah Cause Vasospasm?mentioning

confidence: 99%

Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Nolan

Macdonald²

2006

FOC

Self Cite

View full text Add to dashboard Cite

✓ The authors tested the null hypothesis that published literature with a high level of evidence does not support the assertion that subarachnoid hemorrhage (SAH) causes cerebral vasospasm, which in turn causes cerebral infarction and poor outcome after aneurysmal SAH. The medical literature on SAH was searched in MEDLINE. The author's personal files of all published literature on SAH were reviewed. References cited in Cochrane reviews as well as the published papers that were reviewed were also retrieved. There is no question that SAH causes what the authors have chosen to call “angiographic vasospasm.” However, the incidence and severity of vasospasm in recent series of patients is not well defined. There is reasonable evidence that vasospasm causes infarction, but again, accurate data on how severe and how diffuse vasospasm has to be to cause infarction and how often vasospasm is the primary cause of infarction are not available. There are good data on the incidence of cerebral infarction after SAH, and these data indicate that it is highly associated with poor outcome. The link between angiographic vasospasm and poor outcome is particularly poorly described in terms of what would be considered data of a high level of evidence. The question as to whether there is a clear pathway from SAH to vasospasm to cerebral infarction to poor outcome seems so obvious to neurosurgeons as to make it one not worth asking. Nevertheless, the obvious is not always true or accurate, so it is important to note that published literature only weakly supports the causative association of vasospasm with infarction and poor outcome after SAH. It behooves neurosurgeons to document this seemingly straightforward pathway with high-quality evidence acceptable to the proponents of evidence-based medicine.

show abstract

Section: Does Sah Cause Vasospasm?mentioning

confidence: 99%

Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Nolan

Macdonald²

2006

FOC

Self Cite

View full text Add to dashboard Cite

show abstract

“…3,7,[16][17][18] The 2 most commonly used scales of Fisher et al 7 and Hijdra et al 8 have come under criticism; authors referred to these scales as rather gross estimators, difficult to apply, lacking quantification, and cumbersome in the clinical setting. 3,17,[19][20][21][22] Moreover, hemorrhage density is not considered in these scales. A quantitative volume and density measurement may reduce interobserver variability in comparison with current scales and would provide physicians with a potentially valuable tool for outcome prediction and treatment guidance.…”

mentioning

confidence: 99%

Automatic Quantification of Subarachnoid Hemorrhage on Noncontrast CT

Boers

Zijlstra²,

Gathier

et al. 2014

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…The percentage of clot cleared each day may be a significant predictor of vasospasm, but the importance of clearance timing remains unknown. 10) Our results suggest that monitoring the SAH volume until day 4 may help to predict the occurrence of SVS.…”

Section: Quantification Of Sah By 3d-ctmentioning

confidence: 92%

“…1,3,5) Attempts to quantify SAH volumetrically with a novel software-based technique and two-dimensional (2D)-CT encountered problems posed by the partial volume effect and the absence of SAH in the convexity or posterior fossa. 4,10) To surmount these problems, we have developed a new method to quantify SAH on three-dimensional (3D)-CT which yield volume data. The present preliminary study was undertaken to develop a method to determine the hematoma volume quantitatively on 3D-CT. Our study was comprised of 3 components: an experimental study (in vitro) to set the CT number in terms of Hounsfield units (HU) and to compare the hematoma volumes acquired in vitro by actual measurements and on 3D-CT; measurement of the SAH volume in patients with aneurysmal SAH; and examination of the correlation between hematoma volume and occurrence of SVS.…”

Section: Introductionmentioning

confidence: 99%

Quantification of Subarachnoid Hemorrhage by Three-Dimensional Computed Tomography: Correlation Between Hematoma Volume and Symptomatic Vasospasm

Sato

Sasaki

Sakuma

et al. 2011

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Subarachnoid hemorrhage (SAH) volume was measured by three-dimensional computed tomography (3D-CT) and the correlation examined between the SAH volume and the occurrence of symptomatic vasospasm (SVS). Experimental (in vitro) hematomas were made with blood obtained from 10 volunteers. The hematoma volume was determined by actual measurements and by 3D-CT using a CT number in the range of 40-80 Hounsfield units (HU) on days 1, 4, 7, 11, and 14. The coefficients on days 1 and 4 were relatively high and the correlation between measured and estimated volumes was significant on days 7, 11, and 14. 3D-CT was also performed in 50 patients with SAH at onset (day 0) and on days 1, 4, 7, and 14. The hematoma volume including the volume of normal structures was automatically calculated (V1). The volume of normal structures (V2) with CT numbers of 40-80 HU was calculated in another 50 patients without intracranial lesions as 12 ml. The total hematoma volume was defined as V1 minus mean V2. The mean SAH volume was 44, 36, 21, 11, and 8 ml on days 0, 1, 4, 7, and 14, respectively. The hematoma volumes were significantly larger in patients with SVS than in patients without SVS at all time points. The minimum hematoma volume in patients with SVS was 92, 76, 42, 24, and 12 ml on days 0, 1, 4, 7, and 14, respectively. This method allows the quantitative determination of SAH volume based on 3D-CT, and may be useful in clinical studies of cerebral vasospasm.

show abstract

Clot volume and clearance rate as independent predictors of vasospasm after aneurysmal subarachnoid hemorrhage

Abstract: Quantitative analysis of subarachnoid clot shows that vasospasm is best predicted by initial subarachnoid clot volume and the percentage of clot cleared per day.

Cited by 167 publications

References 39 publications

Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Automatic Quantification of Subarachnoid Hemorrhage on Noncontrast CT

Quantification of Subarachnoid Hemorrhage by Three-Dimensional Computed Tomography: Correlation Between Hematoma Volume and Symptomatic Vasospasm

Contact Info

Product

Resources

About