Radiological scales predicting delayed cerebral ischemia in subarachnoid hemorrhage: systematic review and meta-analysis

Steen, Wessel E. van der; Leemans, Eva L.; Berg, René van den; Roos, Yvo B.W.E.M.; Marquering, Henk A.; Verbaan, Dagmar; Majoie, Charles B. L. M.

doi:10.1007/s00234-019-02161-9

Cited by 59 publications

(52 citation statements)

References 71 publications

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“…e severity of SAH is concerned that it may be the stimulant factor to develop DNID. e literature showed that 40%-70% of ruptured aneurysms patients with highgrade WFNS developed DNID [10,11], whereas FS was demonstrated to be associated with DNID of 55% with multivariable analysis and of 62% with univariable analysis [12]. Moreover, our study considered the types of general anesthetic agents as confounding factors; thus, the simple random sampling with 1 : 2 matching based on WFNS, FS, and general anesthetic agents was conducted for patients distribution as 1 case in the DNID group and 2 controls in the non-DNID group that showed no statistically significant difference between both the groups (p > 0.99) ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Thongrong

Kasemsiri

Duangthongphon

et al. 2020

Anesthesiology Research and Practice

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Background. Delayed ischemic neurologic deficit (DNID) is a problem after cerebral aneurysm clipping. Intraoperative hypotension seems to be indicated as a risk factor, but it remains a controversial issue with varying low-blood pressure levels accepted. Methods. A retrospective, hospital-based, case-control study was performed with patients who received general anesthesia for cerebral aneurysm clipping. 42 medical record charts were randomly selected and matched 1 : 2 (1 case with DNID : 2 controls without DNID) based on the type of general anesthetic techniques and severity of subarachnoid hemorrhage. The optimal cutoff points of hemodynamic response were calculated by the area under the curve. Results. Data suggested that the optimal cutoff points for lowest blood pressure for prevention of DNID should be systolic blood pressure (SBP) of 95 mmHg (sensitivity of 78.6%; specificity of 53.6%), diastolic blood pressure (DBP) of 50 mmHg (sensitivity of 71.4%; specificity of 67.9%), and mean arterial pressure (MAP) of 61.7 mmHg (sensitivity of 85.7%; specificity of 35.7%). Furthermore, the optimal cutoff point mean difference baseline blood pressure was recommended as Δ SBP of 36 mmHg (sensitivity of 85.7%; specificity of 60.7%), Δ DBP of 27 mmHg (sensitivity of 92.9%; specificity of 71.4%), and Δ MAP of 32 mmHg (sensitivity of 92.9%; specificity of 85.7%). No significant difference between DNID and non-DNID groups was found for end-tidal carbon dioxide (ETCO2) and has poor diagnostic value for predicting DNID. Conclusion. To prevent DNID, we recommend that optimal blood pressure should not be lower than 95 for SBP, 50 for DBP, and 61.7 mmHg for MAP. Additionally, we suggest that Δ SBP, Δ DBP, and Δ MAP should be less than 36, 27, and 32 mmHg, respectively.

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Section: Discussionmentioning

confidence: 99%

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Thongrong

Kasemsiri

Duangthongphon

et al. 2020

Anesthesiology Research and Practice

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“…However, several studies demonstrated low sensitivity and specificity of this scale for predicting DCI [6][7][8][9][10]. Recently, a systematic review assessing the association of radiological scales for grading aSAH with DCI showed that patients with Fisher grade 4 have a significantly lower risk of DCI compared to those with Fisher grade 3 [13]. With current clinical management including nimodipine, hypertensive therapy, and endovascular treatment, the Fisher grade predicts symptomatic vasospasm in only half of cases [14].…”

mentioning

confidence: 99%

Computed tomography in the assessment of aneurysmal subarachnoid haemorrhage for clinical outcome: an observational cohort study

Couret

Boussen

Cardoso

et al. 2020

Preprint

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Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening event with major complications such as delayed cerebral infarction (DCI) or acute hydrocephalus and poor neurological outcome. DCI occurs most frequently 7 days after aSAH and can last for a prolonged period. The ability to predict these complications would allow the neuro-intensivist to identify patients at risk and select the most appropriate unit for hospitalization. Methods: A 3-year single-centre retrospective cohort study was conducted in our neuroscience critical care unit. Initial computed tomography (CT) scans in patients hospitalized for aSAH were blindly assessed using eight grading systems: the Fisher scale, modified Fisher scale, Barrow Neurological Institute scale, Hijdra scale, Intraventricular Haemorrhage (IVH) score, Graeb score, and LeRoux score. We evaluated and compared these radiological scales for the early prediction of DCI, acute hydrocephalus, and poor neurological outcome at 3 months. Results: Of 200 patients with aSAH who survived to day 7 and were included for DCI analysis, 39% cases were complicated with DCI. The Hijdra scale was the best predictor for DCI, with a receiver operating characteristic area under the curve (ROCAUC) of 0.80 (95% confidence interval [CI], 0.74–0.85). The ideal cut-off score for all patients was 20/42, with a sensitivity of 85% (95% CI, 75%–94%) and specificity of 63% (95% CI, 54%–71%). The IVH score was the most effective grading system for predicting acute hydrocephalus, with a ROC AUC of 0.85 (95% CI, 0.79–0.89). In multivariate analysis, the Hijdra scale was the only independent predictor of the occurrence of DCI (hazard ratio, 1.18; 95% CI, 1.10–1.27). Conclusions: Although these results have yet to be prospectively confirmed, our findings suggest that the Hijdra scale may be a good predictor of DCI and could be useful in daily clinical practice.

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“…This includes prescribing nimodipine (a calcium channel blocker that has been proven to improve outcome, probably through influencing cortical spreading ischaemia and microthromboembolism) [26][27][28] , maintaining normal intravascular volume status, temperature, electrolytes, glucose and adequate cerebral perfusion pressure by maintaining adequate blood pressure. 13,29 Prophylactic use of hypervolaemia 30,31 or balloon angioplasty 32 in order to improve CBF has been found non beneficial in improving outcome after aSAH.…”

Section: Definition Of DCImentioning

confidence: 99%

“…[33][34][35] However, a meta-analysis showed that only induced hypertension seemed capable of improving CBF, with hypervolaemia being associated with increased risk of complications and haemodilution causing a decrease in oxygen delivery to the brain despite increased CBF. 30 Therefore, several international guidelines nowadays advise treating DCI with induced hypertension combined with euvolemia. 29,36 However, even though induced hypertension is reported to reverse signs of DCI in up to two-thirds of treated patients 37 , sound evidence of its effectiveness is lacking and it is unclear whether induced hypertension actually leads to improved functional outcome.…”

Section: Treating DCImentioning

confidence: 99%

“…Induced hypertension was the only component of the socalled "Triple-H" therapy that seemed promising in increasing CBF in patients with DCI. 30 However, sound evidence of its effect on CBF or on functional outcome was lacking. Therefore, we designed a randomised clinical trial comparing the effectiveness of induced hypertension versus no induced hypertension on improving CBF and functional outcome in DCI patients.…”

Section: Outline Of the Thesismentioning

confidence: 99%

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Strategies for prevention and treatment of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

Gathier¹

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any means, electronic or mechanical, including photocopying, recording or any information storage or retrieval system, without prior permission in writing from the author. The copyright of articles that have been published or accepted for publication has been transferred TABLE OF CONTENTS PART I INTRODUCTION Chapter 1 General introduction PART II FACTORS ASSOCIATED WITH THE DEVELOPMENT OF DCI Chapter 2 Association of automatically quantified total blood volume with delayed cerebral ischaemia Chapter 3 Blood pressure and the risk of delayed cerebral ischaemia and rebleeding Chapter 4 Association of preventive antibiotics with delayed cerebral ischaemia PART III INDUCED HYPERTENSION FOR TREATMENT OF DCI Chapter 5 HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA): a randomised single-blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischaemia after subarachnoid haemorrhage Chapter 6 Effects of induced hypertension on cerebral perfusion in delayed cerebral ischaemia Chapter 7 Effects of induced hypertension on functional outcome in delayed cerebral ischaemia Chapter 8 Slow recruitment in the HIMALAIA Study: lessons for future clinical trials in patients with delayed cerebral ischaemia PART IV GENERAL DISCUSSION Chapter 9 General discussion and future directions

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Radiological scales predicting delayed cerebral ischemia in subarachnoid hemorrhage: systematic review and meta-analysis

Cited by 59 publications

References 71 publications

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Computed tomography in the assessment of aneurysmal subarachnoid haemorrhage for clinical outcome: an observational cohort study

Strategies for prevention and treatment of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

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