Jan-Karl Burkhardt1, Marian Christoph Neidert2, Martin Nikolaus Stienen3,4, Daniel Schöni5, Christian Fung5, Michel Roethlisberger6, Marco Vincenzo Corniola4, David Bervini5, Rodolfo Maduri7, Daniele Valsecchi8, Sina Tok2, Bawarjan Schatlo9, Philippe Bijlenga4, Karl Schaller4, Oliver Bozinov2, Luca Regli2. 1. Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Jan-karl.Burkhadt@usz.ch. 2. Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 3. Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland. 4. Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland. 5. Department of Neurosurgery, Inselspital Bern, Bern, Switzerland. 6. Department of Neurosurgery, University Clinic Basel, Basel, Switzerland. 7. Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. 8. Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland. 9. Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany.
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.
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.
Authors: Andrea Morotti; Javier M Romero; Michael J Jessel; Andrew M Hernandez; Anastasia Vashkevich; Kristin Schwab; Joseph D Burns; Qaisar A Shah; Thomas A Bergman; M Fareed K Suri; Mustapha Ezzeddine; Jawad F Kirmani; Sachin Agarwal; Angela Hays Shapshak; Steven R Messe; Chitra Venkatasubramanian; Katherine Palmieri; Christopher Lewandowski; Tiffany R Chang; Ira Chang; David Z Rose; Wade Smith; Chung Y Hsu; Chun-Lin Liu; Li-Ming Lien; Chen-Yu Hsiao; Toru Iwama; Mohammad Rauf Afzal; Christy Cassarly; Steven M Greenberg; Renee' Hebert Martin; Adnan I Qureshi; Jonathan Rosand; John M Boone; Joshua N Goldstein Journal: Neuroradiology Date: 2017-07-20 Impact factor: 2.804