Dissociation of Early and Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

Ayling, Oliver G S; Ibrahim, George M.; Alotaibi, Naif M.; Gooderham, Peter; Macdonald, R. Loch

doi:10.1161/strokeaha.116.014794

Cited by 51 publications

(40 citation statements)

References 40 publications

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“…On review of the literature, previous large-scale studies examining the incidence of cerebral infarction after aSAH (defined as hypodensities visualized on CT images) observed a putative infarction rate during admission ranging from 29.8% to 61.3% (mean 44.0%, n = 4), 4,12,14,21 with a mean rate among surgically treated patients of 44.7% (SD 14.2%). In addition, similar to our study, the rate of postprocedural infarction was typically higher among patients treated with clipping, 4,14,21 with 1 exception.…”

Section: Discussionmentioning

confidence: 97%

“…The cutoff of 10 ml 3 was chosen on the basis of previous work suggesting that infarctions of this size are associated with poor functional outcome after clipping of ruptured aneurysms. 4 Hypodensity volumes were determined using the xyz/2 method, with x, y, and z representing the maximal dimensions of the infarct in 3 orthogonal planes. and range, and as frequency and percentage, respectively.…”

Section: Patient Characteristics and Covariates Of Interestmentioning

confidence: 99%

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Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Rinaldo¹,

Hughes²,

Rabinstein

et al. 2018

Journal of Neurosurgery

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OBJECTIVE It has been suggested that increased body mass index (BMI) may confer a protective effect on patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH). Whether the modality of aneurysm occlusion influences the effect of BMI on patient outcomes is not well understood. The authors aimed to compare the effect of BMI on outcomes for patients with aSAH treated with surgical clipping versus endovascular coiling. METHODS The authors retrospectively reviewed the outcomes for patients admitted to their institution for the management of aSAH treated with either clipping or coiling. BMI at the time of admission was recorded and used to assign patients to a group according to low or high BMI. Cutoff values for BMI were determined by classification and regression tree analysis. Predictors of poor functional outcome (defined as modified Rankin Scale score > 2 measured ≥ 90 days after the ictus) and posttreatment cerebral hypodensities detected during admission were then determined separately for patients treated with clipping or coiling using stepwise multivariate logistic regression analysis. RESULTS Of the 469 patients admitted to the authors' institution with aSAH who met the study's inclusion criteria, 144 were treated with clipping and 325 were treated with coiling. In the clipping group, the frequency of poor functional outcome was higher in patients with BMI ≥ 32.3 kg/m (47.6% vs 19.0%; p = 0.007). In contrast, in the coiling group, patients with BMI ≥ 32.3 kg/m had a lower frequency of poor functional outcome at ≥ 90 days (5.8% vs 30.9%; p < 0.001). On multivariate analysis, high BMI was independently associated with an increased (OR 3.92, 95% CI 1.20-13.41; p = 0.024) and decreased (OR 0.13, 95% CI 0.03-0.40; p < 0.001) likelihood of poor functional outcome for patients treated with clipping and coiling, respectively. For patients in the surgical group, BMI ≥ 28.4 kg/m was independently associated with incidence of cerebral hypodensities during admission (OR 2.44, 95% CI 1.16-5.25; p = 0.018) on multivariate analysis. For patients treated with coiling, BMI ≥ 33.2 kg/m was independently associated with reduced odds of hypodensities (OR 0.45, 95% CI 0.21-0.89; p = 0.021). CONCLUSIONS The results of this study suggest that BMI may differentially affect functional outcomes after aSAH, depending on treatment modality. These findings may aid in treatment selection for patients with aSAH.

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Section: Discussionmentioning

confidence: 97%

Section: Patient Characteristics and Covariates Of Interestmentioning

confidence: 99%

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Rinaldo¹,

Hughes²,

Rabinstein

et al. 2018

Journal of Neurosurgery

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“…Delayed cerebral ischemia usually occurs within two weeks of aSAH and is a common and severe complication of aSAH. The results of medicinal treatment for DCI are often not satisfactory, and it usually leads to permanent damage to neurological functions, resulting in disability or even death of SAH patients(Al-Mufti et al, 2019;Ayling, Ibrahim, Alotaibi, Gooderham, & Macdonald, 2016;Budohoski et al, 2012;Macdonald, 2014;Ostergaard et al, 2013).If early prognosis of the risk of DCI could be achieved, optimized care and improved allocation of healthcare resources might be facilitated. Although qualitative or semiquantitative clinical grades (such as WFNS grade and modified Fisher grade) are well known…”

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confidence: 99%

Early stage neuroglobin level as a predictor of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

et al. 2020

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Background The neuroglobin (Ngb) is well recognized as a potential biomarker for the hypoxic‐ischemic brain injury. However, connection between Ngb and delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is still unclear. Objective To investigate the relationship between early stage Ngb level of aSAH patient and the occurrence of DCI. Methods We evaluated 126 aSAH patients who were enrolled into a prospective observational cohort study. Serum Ngb level on days 1, 2, 3, 5, and 7 after aSAH were determined using a commercial enzyme‐linked immunosorbent assay kit. The relationship between Ngb level and DCI was analyzed. Results Forty‐six (36.5%) aSAH patients experienced DCI. Patients with DCI had significantly higher Ngb levels than those without (p < .001). Multivariate model analysis revealed that day 3 Ngb level remained a significant factor after adjusting for World Federation of Neurosurgical Societies (WFNS) grade, modified Fisher grade, clipping and Ngb levels on days 1, 2, 5, and 7. Sensitivity, specificity, and Youden index of day 3 Ngb level for identifying DCI were derived as 73.9%, 72.5%, and 0.46, respectively, based on the best threshold of 8.4 ng/ml. Regardless in good‐grade group or in poor‐grade group, patients having day 3 Ngb level > 8.4 ng/ml has a significantly worse DCI survival rate than those having day 3 Ngb level <=8.4 ng/ml (p = .026 and .009, respectively). Conclusions Serum Ngb level was significantly elevated in DCI patients. Early stage aSAH Ngb level has the potential of being used as a novel DCI occurrence predictor, especially when Ngb level was combined with WFNS grade.

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“…Tsyben et al (17) reported 2 patients with delayed ischemic deficit due to vasospasm after non-ruptured aneurysm surgery. Clipping is an independent risk factor for the development of early cerebral infarcts, whereas delayed cerebral infarcts are associated with angiographic vasospasm (18). In a study dealing with the prevention of vasospasm, Kawahara et al (19) recommended to perform early lumbar drainage in patients with SAH.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical clipping of anterior circle of willis aneurysms: a retrospective study

Eren¹,

Güzey²,

Yücel³

et al. 2017

Bagcilar Medical Bulletin

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Objective: The surgical outcomes of anterior circle of Willis aneurysms were evaluated. Material and Methods: Between March 2015 and December 2016, 38 patients were operated and followed up for aneurysms. There were 15 female and 23 male patients with a mean age of 47 years (range: 17-78). Of the patients, 35 were diagnosed with subarachnoid hemorrhage (SAH). Of these patients, 54.2% (n=19) were operated within the first 24 hours. All patients were operated by the same surgeon with sylvian dissection. All clinical data in the hospital charts and outpatient records and radiological investigations stored in the archive were evaluated retrospectively. Results:The most commonly seen aneurysm was on the anterior communicating artery (44.8%). After that, aneurysms on the middle cerebral artery (31.6%), posterior communicating artery (13.2%), internal cerebral artery bifurcation (7.8%), and distal anterior cerebral artery were seen, respectively. There was a significant correlation between the location of the aneurysm and the mean age (p=0.009). All patients were followed in the intensive care unit after operation. After surgery, vasospasm was observed in 26.3% of patients. Patients with high SAH grade developed vasospasm significantly more frequently (p=0.03). Neurological examinations at discharge were normal in 17 patients with SAH and 3 patients without SAH. Four patients were discharged with minimal neurological deficit and 2 patients with severe deficit. Eight patients with World Federation of Neurosurgical Societies (WFNS) grade 4-5, 2 patients with grade 3, and 2 patients with grade 1-2 were lost. Postoperative Glasgow Coma Scale and SAH WFNS grades were found to be determinants for dying. Conclusion: Despite the development of endovascular techniques in the treatment of aneurysm, microsurgical clipping remains the first choice method to treat anterior system aneurysms. Closure of the aneurysm is the treatment priority. It is well known that early surgery reduces mortality and morbidity. Keywords: aneurysm, clip, aneurysm surgery, microsurgical clipping, subarachnoid hemorrhage, circle of Willis ÖZET Willis poligonu anterior dolaşım anevrizmalarının mikroşirurjikal yöntemle klipslenmesi: Retrospektif çalışmaAmaç: Willis poligonu anterior sistem anevrizmalarının cerrahi sonuçlarının değerlendirilmesi. Yöntem ve Gereçler: Mart 2015-Aralık 2016 arasında intrakranyal anevrizma nedeniyle kliniğimizde ardı ardına 38 hasta ameliyat edildi. On beş kadın ve 23 erkek hastanın yaş ortalaması 47 (aralığı: 17-78) idi. Otuz beş hastada subaraknoid kanama (SAK) vardı ve bunların %54,2'si (n=19) ilk 24 saatte ameliyata alındı. Hastalar aynı cerrah tarafından silviyan diseksiyon yöntemi kullanılarak opere edildi. Çalışmamız klinik kayıt ve radyolojik görüntü arşivleri kullanılarak retrospektif olarak gerçekleştirildi. Bulgular: En fazla anterior komminikan arter anevrizması görüldü (44.8%). Sonra sırasıyla middle serebral arter (31.6 %), posterior komunikan arter (13.2 %), internal serebral arter (7.8%) ve distal anteri...

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Dissociation of Early and Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

Cited by 51 publications

References 40 publications

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Early stage neuroglobin level as a predictor of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

Microsurgical clipping of anterior circle of willis aneurysms: a retrospective study

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