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Cerebral circulation time on DSA during endovascular treatment in WFNS grade I aneurysmal SAH patients—a predictor of DCI?

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Delayed cerebral ischemia (DCI) remains a contributor to poor outcome following aneurysmal subarachnoid hemorrhage (aSAH). We evaluated cerebral circulation time (CCT) on digital subtraction angiography (DSA) during endovascular treatment (EVT) in WFNS grade I aSAH patients as a predictor of DCI.

Methods

Of 135 consecutive WNFS grade I aSAH patients, 90 were included. Age, gender, time of DSA from ictus (< 72 h or > 72 h), Fisher scale, severe vasospasm, development of DCI, EVD-dependent hydrocephalus, re-bleeding, and procedural complications were recorded. CCT was calculated retrospectively from multiphase DSA. Association with DCI was established through univariate and, subsequently, multivariable logistic regression. An optimal threshold value was identified using ROC curve analysis. Patient groups defined by threshold CCT value, DCI, and, subsequently, time of DSA from ictus were analyzed using χ2 and Fisher’s exact test.

Results

CCT was the only significant factor in the multivariable logistic regression for the outcome development of DCI (OR/second increase in CCT = 1.46 [95% CI 1.14–1.86, p = .003]). When CCT was dichotomized at 8.5 s, the odds ratio for developing DCI was 7.12 (95% CI 1.93–26.34, p = .003) for CCT > 8.5 s compared with < 8.5 s. There was a significant difference for DCI in all patient groups dichotomized by CCT < 8.5 s and > 8.5 s (all patients, p = .001; patients imaged before and after 72 h of ictus, p = .024 and p = .034, respectively).

Conclusion

A CCT > 8.5 s on DSA during EVT in WFNS grade I aSAH patients is associated with an increased risk of developing DCI and may aid in the management of high-risk patients.

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Data availability

Data are available upon reasonable request from Dr. René van den Berg; r.vdberg@amsterdamumc.nl.

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Authors and Affiliations

  1. Department of Neuroradiology, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands

    Mark Schembri, Bart J. Emmer, Charles B. L. M. Majoie & René van den Berg

  2. Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers (Location AMC), Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands

    Dagmar Verbaan, Bert A. Coert & W. Peter Vandertop

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  1. Mark Schembri
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Contributions

Study concepts/study design, MS, RvdB; data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agree to ensure any questions related to the work are appropriately resolved, all authors.

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Correspondence to Mark Schembri.

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Ethics approval

The Medical Research Involving Human Subjects Act does not apply to this study and therefore an approval of the Institutional Medical Ethics Review Committee was not necessary.

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For this type of study, formal consent is not required.

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No identifying data was included in the current study.

Competing interests

RvdB reports a consultancy agreement with Cerenovus neurovascular outside the submitted work (paid to institution). CBLMM reports grants from TWIN, during the conduct of the study, and grants from CVON/Dutch Heart Foundation, European Commission, Dutch Health Evaluation Program, and from Stryker outside the submitted work (paid to institution) and is a shareholder of Nico-lab. All other authors did not receive support from any organization for the submitted work, had no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and had no other relationships or activities that could appear to have influenced the submitted work.

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Schembri, M., Verbaan, D., Emmer, B.J. et al. Cerebral circulation time on DSA during endovascular treatment in WFNS grade I aneurysmal SAH patients—a predictor of DCI?. Neuroradiology 63, 2131–2138 (2021). https://doi.org/10.1007/s00234-021-02749-0

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