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The impact of perfusion computed tomography on the diagnosis and outcome of delayed cerebral ischemia after subarachnoid hemorrhage

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Abstract

Background

Delayed cerebral ischemia (DCI) is a preventable cause of poor neurological outcome in aneurysmal subarachnoid hemorrhage (aSAH). Advances in radiological methods, such as cerebral perfusion computed tomography (CTP), could help diagnose DCI earlier and potentially improve outcomes in aSAH. The objective of this study was to assess whether the use of CTP to diagnose DCI early could reduce the risk of infarction related to DCI.

Methods

Retrospective cohort study of patients in the intensive care unit of Erasme Hospital (Brussels, Belgium) between 2004 and 2021 with aSAH who developed DCI. Patients were classified as: “group 1” − DCI diagnosed based on clinical deterioration or “group 2” − DCI diagnosed using CTP. The primary outcome was the development of infarction unrelated to the initial bleeding or surgery.

Results

211 aSAH patients were diagnosed with DCI during the study period: 139 (66%) in group 1 and 72 (34%) in group 2. In group 1, 109 (78%) patients developed a cerebral infarction, compared to 45 (63%) in group 2 (p = 0.02). The adjusted cumulative incidence of DCI over time was lower in group 2 than in group 1 [hazard ratio 0.65 (95% CI 0.48–0.94); p = 0.02]. The use of CTP to diagnose DCI was not independently associated with mortality or neurological outcome.

Conclusions

The use of CTP to diagnose DCI might help reduce the risk of developing cerebral infarction after aSAH, although the impact of such an approach on patient outcomes needs to be further demonstrated.

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Data availability

The datasets analyzed for this study can be found in the supplementary electronic material.

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Funding

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Author information

Authors and Affiliations

  1. Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium

    Mohamed Seyour, Michele Salvagno, Raphael Rozenblum, Elisabetta Macchini, Marco Anderloni, Lorenzo Peluso, Filippo Annoni, Fabio Silvio Taccone & Elisa Gouvea Bogossian

  2. Department of Neurology, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium

    Lise Jodaitis & Nicolas Gaspard

  3. Department of Radiology, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium

    Valentina Lolli

  4. Department of Neurosurgery, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium

    Sophie Schuind

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Contributions

MS, MS, FST, and EGB contributed to conception and design of the study. MS, MS, EM, DD, MM, NND, collected data and organized the database. EGB performed the statistical analysis. MS, MS, EGB and FST wrote the first draft of the manuscript. FA, LP, SS, LJ, NG and JC wrote sections of the manuscript and revised it for intellectual content. All authors contributed to manuscript revision, read, and approved the submitted version.

Corresponding author

Correspondence to Elisa Gouvea Bogossian.

Ethics declarations

Ethical approval and Informed consent statement

This study was approved by Erasme Hospital Ethics Committee under the protocol number P2021/588. Due to the retrospective nature of the study the need for informed written consent was waived by the Erasme Ethics Committee. All methods were carried out in accordance with relevant guidelines and regulations in the declaration of Helsinki.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Seyour, M., Salvagno, M., Rozenblum, R. et al. The impact of perfusion computed tomography on the diagnosis and outcome of delayed cerebral ischemia after subarachnoid hemorrhage. Neurol Sci 45, 1135–1144 (2024). https://doi.org/10.1007/s10072-023-07115-x

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