Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage

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.

Appendix

Swiss SOS Study Group Members / Collaborators:

Ali-Reza Fathi, MD, Javier Fandino, MD, Serge Marbacher, MD, Donato D'Alonzo, MD, Hassen Kerkeni, MD, Jahuda Soleman, MD, Daniel Coluccia, MD, Carl Muroi, MD, Hiroki Danura, MD: Department of Neurosurgery, Kantonsspital Aarau; Nicole Schmid, PhD: Neuropsychological Unit, Department of Neurology, Kantonsspital Aarau, Switzerland; Daniel Zumofen, MD, Michel Röthlisberger, MD, Luigi Mariani, MD, Rahael Guzman, MD, PhD: Department of Neurosurgery, Universitätsspital Basel; Andreas U. Monsch, PhD, Stephan Bläsi, PhD: Neuropsychological Unit, Department of Neurology, Universitätsspital Basel, Switzerland; Christian Fung, MD, David Bervini, MD, Jürgen Beck, MD, Andreas Raabe, MD, Johannes Goldberg, MD, Daniel Schöni, MD: Department of Neurosurgery, Inselspital Bern; Jan Gralla, MD: Department of Neuroradiology, Inselspital Bern; Antoinette Zweifel-Zehnder, PhD, Klemens Gutbrod, MD, Rene Müri, PhD: Neuropsychological Unit, Department of Neurology Inselspital Bern, Switzerland; Rodolfo Maduri, MD, Roy Thomas Daniel, MD, Daniele Starnoni, MD, Mahmoud Messerer, MD, Marc Levivier, MD: Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne; Valérie Beaud, PhD: Neuropsychological Unit, Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Daniele Valsecchi, MD, Marta Arrighi, MD, Alice Venier, MD, Michael Reinert, MD Dominique E. Kuhlen, MD, Thomas Robert, MD: Department of Neurosurgery, Ente Ospedaliero Cantonale Lugano, Lugano; Stefania Rossi, PhD, Leonardo Sacco, MD: Neuropsychological Unit, Department of Neurology, Ente Ospedaliero Cantonale Lugano, Lugano, Switzerland; Philippe Bijlenga, MD, PhD, Marco Corniola, MD, Karl Schaller, MD: Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva; Christian Chicherio, PhD: Neuropsychological Unit, Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland; Martin A. Seule, MD, Andrea Ferrari, MD, Astrid Weyerbrock, MD, Martin Hlavica, MD, Jean-Yves Fournier, MD: Department of Neurosurgery, Kantonsspital St.Gallen; Severin Früh, PhD: Neuropsychological Unit, Department of Neurology, Kantonsspital St.Gallen, Switzerland; Bawarjan Schatlo, MD: Department of Neurosurgery, Universitätsmedizin Göttingen, Göttingen, Germany; Jan-Karl Burkhardt, MD, Martin N. Stienen, MD, Emanuela Keller, MD, Luca Regli, MD, Oliver Bozinov, MD, Nicolai Maldaner, MD, Sina Tok, MD, Marian C. Neidert, MD: Department of Neurosurgery, Universitätsspital Zürich, Universität Zürich; Peter Brugger, PhD, Christian Mondadori, PhD: Neuropsychological Unit, Department of Neurology, Universitätsspital Zürich, Universität Zürich, Switzerland.