Early Hemodynamic Changes Based on Initial Color-Coding Angiography as a Predictor for Developing Subsequent Symptomatic Vasospasm After Aneurysmal Subarachnoid Hemorrhage
机构：[1]Department of Neurological Surgery,University of California San Francisco, San Francisco, California, USA[2]Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, California, USA[3]Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA[4]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China重点科室诊疗科室神经外科神经外科首都医科大学附属天坛医院[5]Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
INTRODUCTION: Prediction of vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) remains imperfect and currently relies on clinical and radiographic characteristics. Whether early hemodynamic changes may refine risk stratification for delayed vasospasm (DV) after aSAH was analyzed. METHODS: Patients with aSAH (n = 53) and a control group with unruptured intracranial aneurysms (UIA) (n = 12) with initial color-coding angiography at admission were included in this study (n = 65). Clinical and radiologic data were collected, and uni-and multivariate analysis was used to correlate the occurrence of DV (manifesting clinically or detected with transcranial Doppler or angiography) with hemodynamic features of the initial angiography including Tmax and mean transit times (MTTs). RESULTS: In the aSAH patient cohort, 37 of 53 patients with aSAH (70%) developed DV. After we controlled for the effects of age, Hunt and Hess grade, and modified Fisher grade, patients with DV had a shorter mean region of interest peak time (Tmax) of the anterior cerebral artery A2 segment (P = 0.036) and the middle cerebral artery M1 (P = 0.045) and M3 (P = 0.013) segments. Mean MTTs between internal carotid artery to middle cerebral artery M3 segment (P = 0.026) was also significantly shorter in patients with DV when compared with controls. CONCLUSIONS: Tmax and MTT on angiography within 48 hours of aneurysm rupture before treatment provide an early quantitative assessment in patients with aSAH and in this small study were predictive for the development of subsequent symptomatic DV. Early identification of patients with aSAH at greatest risk of DV may ameliorate clinical outcome through timely, selective implementation of aggressive prophylactic therapy to prevent the effects of DV.
第一作者机构：[1]Department of Neurological Surgery,University of California San Francisco, San Francisco, California, USA
共同第一作者：
通讯作者：
通讯机构：[1]Department of Neurological Surgery,University of California San Francisco, San Francisco, California, USA[2]Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, California, USA[5]Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
推荐引用方式(GB/T 7714)：
Burkhardt Jan-Karl,Chen Xiaolin,Winkler Ethan A.,et al.Early Hemodynamic Changes Based on Initial Color-Coding Angiography as a Predictor for Developing Subsequent Symptomatic Vasospasm After Aneurysmal Subarachnoid Hemorrhage[J].WORLD NEUROSURGERY.2018,109:E363-E373.doi:10.1016/j.wneu.2017.09.179.
APA：
Burkhardt, Jan-Karl,Chen, Xiaolin,Winkler, Ethan A.,Weiss, Miriam,Yue, John K....&Lawton, Michael T..(2018).Early Hemodynamic Changes Based on Initial Color-Coding Angiography as a Predictor for Developing Subsequent Symptomatic Vasospasm After Aneurysmal Subarachnoid Hemorrhage.WORLD NEUROSURGERY,109,
MLA：
Burkhardt, Jan-Karl,et al."Early Hemodynamic Changes Based on Initial Color-Coding Angiography as a Predictor for Developing Subsequent Symptomatic Vasospasm After Aneurysmal Subarachnoid Hemorrhage".WORLD NEUROSURGERY 109.(2018):E363-E373
