Highlights
- •Delayed cerebral ischemia is a poorly predictable complication occurring after aneurysmal subarachnoid hemorrhage.
- •Identified high risk patients allows close monitoring.
- •Cisternal amount of blood evaluated after initial resuscitation is correlated to risk of delayed cerebral ischemia.
- •High cisternal clot clearance rate seems associated with low probability of delayed cerebral ischemia.
Abstract
Delayed cerebral ischemia (DCI) is a poorly predictable complication occurring after
aneurysmal subarachnoid hemorrhage (SAH) that can have dramatic functional consequences.
Identifying the patients with the highest risk of DCI may help to institute more suitable
monitoring and therapy. Early brain injuries and aneurysm-securing procedure complications
could be regarded as confounding factors leading to severity misjudgment. After an
early resuscitation phase, a subacute assessment may be more relevant to integrate
the intrinsic SAH severity.
A retrospective analysis was performed upon patients prospectively included in the
registry of SAH patients between July 2015 to April 2020. The amount of cisternal
and intraventricular blood were assessed semi-quantitatively on acute and subacute
CT scans performed after early resuscitation. A clot clearance rate was calculated
from their comparison. The primary endpoint was the occurrence of a DCI.
A total of 349 patients were included in the study; 80 (22.9%) experienced DCI. In
those patients, higher Fisher grades were observed on acute (p = 0.026) and subacute
(p = 0.003) CT scans. On the subacute CT scan, patients who experienced DCI had a
higher amount of blood, either at the cisternal (median Hijdra sum score: 11 vs 5,
p < 0.001) or intraventricular (median Graeb score: 4 vs 2, p < 0.001) level. There
was a negative linear relationship between the cisternal clot clearance rate and the
risk of DCI.
The assessment of the amount of subarachnoid blood and clot clearance following resuscitation
after aneurysmal SAH can be useful for the prediction of neurological outcome.
Keywords
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Article info
Publication history
Accepted:
February 6,
2021
Received:
August 1,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
