CT Perfusion and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Cremers, Charlotte H. P.; Schaaf, Irene C. van der; Wensink, G. Emerens; Greving, Jacoba P.; Rinkel, Gabriël J.E.; Velthuis, Birgitta K.; Vergouwen, Mervyn D.I.

doi:10.1038/jcbfm.2013.208

Cited by 105 publications

(67 citation statements)

References 26 publications

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“…3 CTP is of practical use and provides accurate estimation of CBF. 5 Several limitations of our study are inherent to using CTP. By assessing CBF in predefined regions, we might have missed areas with more severe perfusion deficits.…”

Section: Discussionmentioning

confidence: 99%

Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Gathier¹,

Dankbaar²,

Jagt³

et al. 2015

Stroke

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Background and Purpose-The presumed effectiveness of induced hypertension for treating delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is based on uncontrolled case-series only. We assessed the effect of induced hypertension on cerebral blood flow (CBF) in aneurysmal subarachnoid hemorrhage patients with delayed cerebral ischemia in a randomized clinical trial. Methods-Aneurysmal subarachnoid hemorrhage patients were randomized to induced or no induced hypertension (control group) at delayed cerebral ischemia onset. CBF was assessed, blinded for treatment allocation, with computed tomographic perfusion in standardized predefined regions at delayed cerebral ischemia onset and after 24 to 36 hours of study treatment. Mean arterial blood pressure was compared between groups (linear mixed model). The primary outcome measure was the difference in change in overall CBF (Mann-Whitney U test). Results-Mean arterial blood pressure was, on average, 12 mm Hg (95% confidence interval, 8.6-14.5) higher in the hypertension group (n=12) than in the control group (n=13). Change in overall CBF (mL/100g per s) was −8.5 (range, −42 to 30) in the control group and 0.1 (range, −31-43) in the hypertension group (P=0.25). Conclusions-Change in overall CBF did not differ to a statistically significant extent between the groups. Based on our results, 225 to 250 patients per group are needed to find a statistically significant difference in change in overall CBF between induced hypertension and no hypertension. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0161323.

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Section: Discussionmentioning

confidence: 99%

Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Gathier¹,

Dankbaar²,

Jagt³

et al. 2015

Stroke

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“…Computed tomography (CT) perfusion is a promising tool for the diagnosis of DCI, but test characteristics of perfusion thresholds are moderate. 3 In addition, the pathogenesis of DCI has not been elucidated. For long it has been thought that DCI is caused by vasospasm of the arteries of the circle of Willis to such an extent that the term vasospasm was used as a synonym for DCI.…”

Section: Introductionmentioning

confidence: 99%

Hemostasis and Fibrinolysis in Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

Boluijt

Meijers

Rinkel

et al. 2015

J Cereb Blood Flow Metab

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Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with microthrombosis, which can result from activated hemostasis, inhibited fibrinolysis, or both. We systematically searched the PUBMED and EMBASE databases to identify hemostatic or fibrinolytic parameters that can be used for the prediction or diagnosis of DCI, or that inform on the pathogenesis of DCI and may serve as treatment targets. We included 24 studies that fulfilled predefined criteria and described 39 biomarkers. Only one study fulfilled predefined criteria for high quality. Since no parameter on admission was associated with DCI and in none of the included studies blood was drawn at the time of clinical deterioration, none of the studied parameters can presently be used for the prediction or diagnosis of DCI. Regarding the pathogenesis of DCI, it was shown that compared with patients without DCI those with DCI had higher levels of von Willebrand factor and platelet activating factor in plasma 5 to 9 days after aSAH, membrane tissue factor in cerebrospinal fluid 5 to 9 days after aSAH, and D-dimer in plasma 11 to 14 days after aSAH. Confirmation in high-quality studies is needed to investigate whether these parameters can serve as targets for new intervention studies.

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“…Perfusion CT has also been used as a predictor of DCI and outcome 45,46 ; however, all imaging studies have the same limitation when used as predictors: the interobserver variability and variation in post-processing between different softwares. We acknowledge that the same limitations probably apply to DTI studies as predictors of DCI or outcome.…”

Section: August 2017mentioning

confidence: 99%

Early Prediction of Delayed Ischemia and Functional Outcome in Acute Subarachnoid Hemorrhage

Fragata

Alves

Papoila

et al. 2017

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Background and Purpose-Diffusion tensor imaging (DTI) parameters are markers of cerebral lesion in some diseases. In patients with acute subarachnoid hemorrhage (SAH), we investigated whether DTI parameters measured at <72 hours might be associated with delayed cerebral ischemia (DCI) and with poor functional outcome at 3 months (modified Rankin Scale score ≥3). Methods-DTI was performed in a prospective cohort of 60 patients with nontraumatic SAH at <72 hours. Association of fractional anisotropy and apparent diffusion coefficient values at <72 hours with the occurrence of DCI and outcome at 3 months was evaluated with logistic regression models, adjusting for known predictors of prognosis. Results-At <72 hours after SAH, fractional anisotropy values at the cerebellum were associated with DCI occurrence (78% less odds of DCI for each 0.1 increase in fractional anisotropy; P=0.019). Early apparent diffusion coefficient values were not associated with DCI. After adjusting for confounding variables, an increase of 10 U in apparent diffusion coefficient at the frontal centrum semiovale corresponded to 15% increased odds of poor outcome (P=0.061). Conclusions-DTI

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CT Perfusion and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Cited by 105 publications

References 26 publications

Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Hemostasis and Fibrinolysis in Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

Early Prediction of Delayed Ischemia and Functional Outcome in Acute Subarachnoid Hemorrhage

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