Abstract
Predictors for cerebral infarction, an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH), were examined. This study used data from the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) cohort, which included 579 patients whose ruptured aneurysms were treated with either clipping or coiling within 12 days of onset. Patient, clinical, radiographic, and treatment variables associated with cerebral infarction were determined. Ruptured aneurysms were clipped in 282 patients and coiled in 297 patients. Cerebral infarction occurred in 162 patients (28.0 %): 101 patients by cerebral vasospasm, 34 patients by clipping, and 33 patients by coiling. Univariate analyses showed that significant factors associated with cerebral infarction development were Fisher computed tomography (CT) group 3 on admission, premature aneurysm rupture during clipping procedure, cerebrospinal fluid drainage, symptomatic vasospasm, endovascular treatment for vasospasm, and shunt-dependent hydrocephalus. Multivariable logistic regression analyses showed that cerebral infarction was significantly associated with Fisher CT group 3 on admission, larger aneurysm dome size, ruptured posterior circulation aneurysms, premature aneurysm rupture during clipping procedure, symptomatic vasospasm, and infection, while endovascular treatment for vasospasm significantly decreased the development of cerebral infarction. The most important potentially treatable factor associated with cerebral infarction was symptomatic vasospasm.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737
Fergusen S, Macdonald RL (2007) Predictors of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 60:658–667
Fu C, Yu W, Sun L, Li D, Zhao C (2013) Early cerebral infarction following aneurysmal subarachnoid hemorrhage: frequency, risk factors, patterns, and prognosis. Curr Neurovasc Res 10:316–324
Hill MD, Martin RH, Mikulis D, Wong JH, Silver FL, Terbrugge KG, Milot G, Clark WM, Macdonald RL, Kelly ME, Boulton M, Fleetwood I, McDougall C, Gunnarsson T, Chow M, Lum C, Dodd R, Poublanc J, Krings T, Demchuk AM, Goyal M, Anderson R, Bishop J, Garman D, Tymianski M, ENACT trial investigators (2012) Safety and efficacy of NA-1 in patients with iatrogenic stroke after endovascular aneurysm repair (ENACT): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet Neurol 11:942–950
Hou J, Zhang JH (2013) Does prevention of vasospasm in subarachnoid hemorrhage improve clinical outcome? No. Stroke 44(Suppl 1):S34–S36
Jabbarli R, Gläsker S, Weber J, Taschner C, Olschewski M, Van Velthoven V (2013) Predictors of severity of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 22:1332–1339
Kanamaru K, Suzuki H, Taki W (2015) Risk factors for vasospasm-induced cerebral infarct when both clipping and coiling are equally available. Acta Neurochir Suppl 120:291–295
Kumar A, Brown R, Dhar R, Sampson T, Derdeyn CP, Moran CJ, Diringer MN (2013) Early vs. delayed cerebral infarction after aneurysm repair after subarachnoid hemorrhage. Neurosurgery 73:617–623
Naidech AM, Drescher J, Tamul P, Shaibani A, Batjer HH, Alberts MJ (2006) Acute physiological derangement is associated with early radiographic cerebral infarction after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 77:1340–1344
Shimoda M, Hoshikawa K, Shiramizu H, Oda S, Yoshiyama M, Osada T, Matsumae M (2010) Early infarction detected by diffusion-weighted imaging in patients with subarachnoid hemorrhage. Acta Neurochir (Wien) 152:1197–1205
Siironen J, Porras M, Varis J, Poussa K, Hernesniemi J, Juvela S (2007) Early ischemic lesion on computed tomography: predictor of poor outcome among survivors of aneurysmal subarachnoid hemorrhage. J Neurosurg 107:1074–1079
Suzuki H, Taki W, Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) group (2013) Effect of aneurysm treatment modalities on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Acta Neurochir Suppl 115:99–105
Taki W, Sakai N, Suzuki H, Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) group (2011) Determinants of poor outcome following aneurysmal subarachnoid hemorrhage when both clipping and coiling are available: PRESAT in Japan. World Neurosurg 76:437–445
Taki W, Sakai N, Suzuki H, Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) group (2012) Factors predicting retreatment and residual aneurysms at 1 year after endovascular coiling for ruptured cerebral aneurysms: PRESAT in Japan. Neuroradiology 54:597–606
Taki W, Sakai N, Suzuki H, Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) group (2013) Importance of independently evaluated initial anatomic result after endovascular coiling for ruptured cerebral aneurysms. J Clin Neurosci 20:527–531
Vergouwen MDI, Vermeulen M, van Gijn J, Rinkel GJE, Wijdicks EF, Muizelaar JP, Mendelow AD, Juvela S, Yonas H, Terbrugge KG, Macdonald RL, Diringer MN, Broderick JP, Dreier JP, Roos YB (2010) Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies. Proposal of a Multidisciplinary Research Group. Stroke 41:2391–2395
Conflict of Interest Statement
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kanamaru, K., Suzuki, H., Taki, W. (2016). Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage. In: Applegate, R., Chen, G., Feng, H., Zhang, J. (eds) Brain Edema XVI. Acta Neurochirurgica Supplement, vol 121. Springer, Cham. https://doi.org/10.1007/978-3-319-18497-5_30
Download citation
DOI: https://doi.org/10.1007/978-3-319-18497-5_30
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-18496-8
Online ISBN: 978-3-319-18497-5
eBook Packages: MedicineMedicine (R0)