학술논문
Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage
Document Type
Original Paper
Author
Burkhardt, Jan-Karl; Neidert, Marian Christoph; Stienen, Martin Nikolaus; Schöni, Daniel; Fung, Christian; Roethlisberger, Michel; Corniola, Marco Vincenzo; Bervini, David; Maduri, Rodolfo; Valsecchi, Daniele; Tok, Sina; Schatlo, Bawarjan; Bijlenga, Philippe; Schaller, Karl; Bozinov, Oliver; Regli, Luca; Fathi, Ali-Reza; Fandino, Javier; Marbacher, Serge; D’Alonzo, Donato; Kerkeni, Hassen; Soleman, Jahuda; Coluccia, Daniel; Muroi, Carl; Danura, Hiroki; Schmid, Nicole; Zumofen, Daniel; Röthlisberger, Michel; Mariani, Luigi; Guzman, Rahael; Monsch, Andreas U.; Bläsi, Stephan; Fung, Christian; Bervini, David; Beck, Jürgen; Raabe, Andreas; Goldberg, Johannes; Schöni, Daniel; Gralla, Jan; Zweifel-Zehnder, Antoinette; Gutbrod, Klemens; Müri, Rene; Maduri, Rodolfo; Daniel, Roy Thomas; Starnoni, Daniele; Messerer, Mahmoud; Levivier, Marc; Beaud, Valérie; Valsecchi, Daniele; Arrighi, Marta; Venier, Alice; Reinert, Michael; Kuhlen, Dominique E.; Robert, Thomas; Rossi, Stefania; Sacco, Leonardo; Bijlenga, Philippe; Corniola, Marco; Schaller, Karl; Chicherio, Christian; Seule, Martin A.; Ferrari, Andrea; Weyerbrock, Astrid; Hlavica, Martin; Fournier, Jean-Yves; Früh, Severin; Schatlo, Bawarjan; Burkhardt, Jan-Karl; Stienen, Martin N.; Keller, Emanuela; Regli, Luca; Bozinov, Oliver; Maldaner, Nicolai; Tok, Sina; Neidert, Marian C.; Brugger, Peter; Mondadori, Christian; on behalf of the Swiss SOS study group
Source
Acta Neurochirurgica: The European Journal of Neurosurgery. July 2017 159(7):1305-1312
Subject
Language
English
ISSN
0001-6268
0942-0940
0942-0940
Abstract
Introduction:To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods:From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS).Results:A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1–416; p < 0.0001). Patients with a spot sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04–8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU.Conclusion:In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative aICH patients.