We've known about this problem a long time! LEADERS SOLVE PROBLEMS! We have NO leaders in stroke!
Delayed cerebral ischemia (6 posts to November 2016)
Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage
Abstract
Background and Objectives
Delayed
cerebral ischemia (DCI) is one of the main contributing factors to poor
clinical outcome after aneurysmal subarachnoid hemorrhage (SAH).
Unsuccessful treatment can cause irreversible brain injury in the form
of DCI-related infarction. We aimed to assess the association between
the location, distribution, and size of DCI-related infarction in
relation to clinical outcome.
Methods
Consecutive
patients with SAH treated at 2 university hospitals between 2014 and
2019 (Helsinki, Finland) and between 2006 and 2020 (Aachen, Germany)
were included. Size of DCI-related infarction was quantitatively
measured as absolute volume (in milliliters). In a semiquantitative
fashion, infarction in 14 regions of interest (ROIs) according to a
modified Alberta Stroke Program Early CT Score (ASPECTS) was noted. The
association of infarction in these ROIs along predefined regions of
eloquent brain, with clinical outcome, was assessed. For this purpose,
1-year outcome was measured by the Glasgow Outcome Scale (GOS) and
dichotomized into favorable (GOS 4–5) and unfavorable (GOS 1–3).
Results
Of
1,190 consecutive patients with SAH, 155 (13%) developed DCI-related
infarction. One-year outcome data were available for 148 (96%) patients.
A median overall infarct volume of 103 mL (interquartile range 31–237)
was measured. DCI-related infarction was significantly associated with
1-year unfavorable outcome (odds ratio [OR] 4.89, 95% CI 3.36–7.34, p
< 0.001). In patients with 1-year unfavorable outcome, vascular
territories more frequently affected were left middle cerebral artery
(affected in 49% of patients with unfavorable outcome vs in 30% of
patients with favorable outcome; p = 0.029), as well as left (44% vs 18%; p = 0.003) and right (52% vs 14%; p < 0.001) anterior cerebral artery supply areas. According to the ASPECTS model, the right M3 (OR 8.52, 95% CI 1.41–51.34, p = 0.013) and right A2 (OR 7.84, 95% CI 1.97–31.15, p = 0.003) regions were independently associated with unfavorable outcome.
Discussion
DCI-related
infarction was associated with a 5-fold increase in the odds of
unfavorable outcome, after 1 year. Ischemic lesions in specific
anatomical regions are more likely to contribute to unfavorable outcome.
Trial Registration Information
Data collection in Aachen was registered in the German Clinical Trial Register (DRKS00030505); on January 3, 2023.
Get full access to this article
View all available purchase options and get full access to this article.
No comments:
Post a Comment