Artikel
Early localisation of tissue at risk for delayed cerebral ischemia after aneurysmal subarachnoid haemorrhage – blood distribution on initial imaging vs. early CT perfusion
Frühe Lokalisation vom “tissue at risk” für verzögerte zerebrale Ischämie nach aneurysmatischer Subarachnoidalblutung: Blutverteilung in der initialen Bildgebung versus frühe CT Perfusion
Suche in Medline nach
Autoren
Veröffentlicht: | 25. Mai 2022 |
---|
Gliederung
Text
Objective: Delayed cerebral ischemia (DCI) is a potentially reversible complication after aneurysmal subarachnoid hemorrhage (aSAH), if early detected and treated. A reliable localization of tissue at risk for DCI is crucial for the implementation of focal monitoring. Computer tomography perfusion (CTP) is widely used for identification of tissue at risk for DCI. While perfusion deficits can be reliably detected at the time of DCI, early perfusion changes before the occurrence of DCI are much subtle. The aim of this study was to compare the predictive power of early CTP with the blood distribution on initial CT for an early localization of tissue at risk for DCI.
Methods: A consecutive cohort of aSAH-patients treated from 2012 to 2020 was retrospectively analyzed. The blood distribution on initial CT was semi-quantitatively evaluated using the Hijdra-score and was documented for each basal artery with a higher score indicating a higher amount of blood surrounding the artery. The vessel territory with the highest surrounding blood amount was considered at risk for DCI. The vessel territory with early perfusion deficits detected on CTP performed on day 3 after ictus was considered at risk for DCI. The vessel territory with delayed infarction (DI) was compared with the anticipated vessel territory at risk for DCI by CTP and by the subarachnoid blood distribution, respectively.
Results: A total of 324 patients were included. DI occurred in 17% (56/324), 71% (40/56) of whom had DI within one vessel territory and 29% (16/56) had multiple infarctions. Perfusion deficits were detected in 82% (46/56) of the patients with DI. An accurate prediction of the vessel territory with infarction was achieved in 85% of the patients with early perfusion deficits (39/46). In 46% (25/56) a vessel territory at risk for DCI could be determined by the subarachnoid blood distribution, in 77% (19/25) of whom the territory with DI was consistent with the predicted vessel territory et risk for DCI. The overall detection rate of tissue at risk was 63% for early CTP and 36% by subarachnoid blood distribution. A combination of both resulted in a detection rate of 84%.
Conclusion: Early CTP showed a higher overall detection rate of tissue at risk for DCI compared to a risk stratification according to blood distribution on admission CT. Especially in patients without early perfusion deficits a consideration of subarachnoid blood distribution may be supportive for identification of vessel territories at risk for DCI.