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Amount of blood during the subacute phase and clot clearance rate as prognostic factors for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

  • Author Footnotes
    1 These authors contributed equally to this work.
    Thomas Ritzenthaler
    Correspondence
    Corresponding author.
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Service de réanimation neurologique, Hôpital neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69 bld Pinel, 69650 BRON Cedex, France
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Florent Gobert
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Service de réanimation neurologique, Hôpital neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69 bld Pinel, 69650 BRON Cedex, France
    Search for articles by this author
  • Baptiste Bouchier
    Affiliations
    Service de réanimation neurologique, Hôpital neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69 bld Pinel, 69650 BRON Cedex, France
    Search for articles by this author
  • Frédéric Dailler
    Affiliations
    Service de réanimation neurologique, Hôpital neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69 bld Pinel, 69650 BRON Cedex, France
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      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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