Purpose

Delayed cerebral ischemia (DCI) remains a contributor to poor outcome following aneurysmal subarachnoid hemorrhage (aSAH). We evaluated cerebral circulation time (CCT) on digital subtraction angiography (DSA) during endovascular treatment (EVT) in WFNS grade I aSAH patients as a predictor of DCI.

Methods

Of 135 consecutive WNFS grade I aSAH patients, 90 were included. Age, gender, time of DSA from ictus (< 72 h or > 72 h), Fisher scale, severe vasospasm, development of DCI, EVD-dependent hydrocephalus, re-bleeding, and procedural complications were recorded. CCT was calculated retrospectively from multiphase DSA. Association with DCI was established through univariate and, subsequently, multivariable logistic regression. An optimal threshold value was identified using ROC curve analysis. Patient groups defined by threshold CCT value, DCI, and, subsequently, time of DSA from ictus were analyzed using χ² and Fisher’s exact test.

Results

CCT was the only significant factor in the multivariable logistic regression for the outcome development of DCI (OR/second increase in CCT = 1.46 [95% CI 1.14–1.86, p = .003]). When CCT was dichotomized at 8.5 s, the odds ratio for developing DCI was 7.12 (95% CI 1.93–26.34, p = .003) for CCT > 8.5 s compared with < 8.5 s. There was a significant difference for DCI in all patient groups dichotomized by CCT < 8.5 s and > 8.5 s (all patients, p = .001; patients imaged before and after 72 h of ictus, p = .024 and p = .034, respectively).

Conclusion

A CCT > 8.5 s on DSA during EVT in WFNS grade I aSAH patients is associated with an increased risk of developing DCI and may aid in the management of high-risk patients.

中文翻译：

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WFNS I 级动脉瘤性 SAH 患者血管内治疗期间 DSA 的脑循环时间——DCI 的预测因子？

目的

迟发性脑缺血 (DCI) 仍然是导致动脉瘤性蛛网膜下腔出血 (aSAH) 后预后不良的一个因素。我们评估了 WFNS I 级 aSAH 患者血管内治疗 (EVT) 期间数字减影血管造影 (DSA) 的脑循环时间 (CCT) 作为 DCI 的预测指标。

方法

在 135 名连续的 WNFS I 级 aSAH 患者中，包括 90 名。记录年龄、性别、来自发作的 DSA 时间（< 72 小时或 > 72 小时）、Fisher 量表、严重血管痉挛、DCI 的发展、EVD 依赖性脑积水、再出血和手术并发症。CCT 是根据多相 DSA 回顾性计算的。与 DCI 的关联是通过单变量和随后的多变量逻辑回归建立的。使用 ROC 曲线分析确定最佳阈值。使用 χ ²和 Fisher 精确检验分析由阈值 CCT 值、DCI 以及随后来自发作的 DSA 时间定义的患者组。

结果

CCT 是 DCI 结果发展的多变量逻辑回归中唯一的重要因素（CCT 的 OR/秒增加 = 1.46 [95% CI 1.14–1.86，p  = .003]）。当 CCT 在 8.5 s 时二分时， CCT > 8.5 s 与 < 8.5 s 相比，发生 DCI 的优势比为 7.12（95% CI 1.93–26.34，p = .003）。在通过 CCT < 8.5 s 和 > 8.5 s 划分的所有患者组中，DCI 存在显着差异（所有患者，p  = .001；在发作前后 72 小时成像的患者，p  = .024 和p  = .034 ，分别）。

结论

WFNS I 级 aSAH 患者在 EVT 期间 DSA 上的 CCT > 8.5 s 与发生 DCI 的风险增加有关，可能有助于管理高风险患者。