A Murphy1, T-Y Lee2, T R Marotta1,3, J Spears3, R L Macdonald4,5,6,7, R I Aviv8, A Baker9, A Bharatha10,3,11. 1. From the Division of Diagnostic and Interventional Neuroradiology (A.M., T.R.M., A. Bharatha). 2. Lawson Health Research Institute and Robarts Research Institute (T.-Y.L.), University of Western Ontario, London, Ontario, Canada. 3. Division of Neurosurgery (T.R.M., J.S., A. Bharatha), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 4. Labatt Family Centre of Excellence in Brain Injury and Trauma Research (R.L.M.). 5. Keenan Research Centre for Biomedical Science (R.L.M.). 6. the Li Ka Shing Knowledge Institute (R.L.M.), St. Michael's Hospital, Toronto, Ontario, Canada. 7. Departments of Physiology and Surgery (R.L.M.). 8. Department of Medical Imaging (R.I.A.), Sunnybrook Hospital, Toronto, Ontario, Canada. 9. Departments of Anesthesia and Critical Care Medicine (A. Baker). 10. From the Division of Diagnostic and Interventional Neuroradiology (A.M., T.R.M., A. Bharatha) BharathaA@smh.ca. 11. Medical Imaging (A. Bharatha), University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND AND PURPOSE: Patients with aneurysmal SAH and good clinical status at admission are considered at a lower risk for delayed cerebral ischemia. Prolonged MTT may be associated with an increased risk. It is unclear whether this is dependent on clinical status. Our purpose was to determine whether increased MTT within 3 days of aneurysmal SAH compared with baseline is associated with a higher risk of delayed cerebral ischemia in patients with good (World Federation of Neurosurgical Societies I-III) versus poor (World Federation of Neurosurgical Societies IV-V) admission status. MATERIALS AND METHODS: This prolonged MTT was a multicenter, prospective cohort investigation of 87 patients with aneurysmal SAH. MTT was measured at admission before aneurysm treatment (MTT1) and following repair (MTT2) within 3 days of admission; MTTdiff was calculated as the difference between MTT2 and MTT1. Changes in MTT across time were assessed with repeated measures analyses. Risk of delayed cerebral ischemia or death was determined with multivariate logistic regression analysis. RESULTS: In patients with a good grade (n = 49), MTT was prolonged in patients who developed delayed cerebral ischemia, with MTTdiff significantly greater (0.82 ± 1.5) compared with those who did not develop delayed cerebral ischemia (-0.14 ± 0.98) (P = .03). Prolonged MTT was associated with a significantly higher risk of delayed cerebral ischemia or death (OR = 3.1; 95% CI, 1.3-7.4; P = .014) on multivariate analysis. In patients with poor grades (n = 38), MTTdiff was not greater in patients who developed delayed cerebral ischemia; MTT1 was significantly prolonged compared with patients with a good grade. CONCLUSIONS: Patients in good clinical condition following aneurysmal SAH but with increasing MTT in the first few days after aneurysmal SAH are at high risk of delayed cerebral ischemia and warrant close clinical monitoring.
BACKGROUND AND PURPOSE:Patients with aneurysmal SAH and good clinical status at admission are considered at a lower risk for delayed cerebral ischemia. Prolonged MTT may be associated with an increased risk. It is unclear whether this is dependent on clinical status. Our purpose was to determine whether increased MTT within 3 days of aneurysmal SAH compared with baseline is associated with a higher risk of delayed cerebral ischemia in patients with good (World Federation of Neurosurgical Societies I-III) versus poor (World Federation of Neurosurgical Societies IV-V) admission status. MATERIALS AND METHODS: This prolonged MTT was a multicenter, prospective cohort investigation of 87 patients with aneurysmal SAH. MTT was measured at admission before aneurysm treatment (MTT1) and following repair (MTT2) within 3 days of admission; MTTdiff was calculated as the difference between MTT2 and MTT1. Changes in MTT across time were assessed with repeated measures analyses. Risk of delayed cerebral ischemia or death was determined with multivariate logistic regression analysis. RESULTS: In patients with a good grade (n = 49), MTT was prolonged in patients who developed delayed cerebral ischemia, with MTTdiff significantly greater (0.82 ± 1.5) compared with those who did not develop delayed cerebral ischemia (-0.14 ± 0.98) (P = .03). Prolonged MTT was associated with a significantly higher risk of delayed cerebral ischemia or death (OR = 3.1; 95% CI, 1.3-7.4; P = .014) on multivariate analysis. In patients with poor grades (n = 38), MTTdiff was not greater in patients who developed delayed cerebral ischemia; MTT1 was significantly prolonged compared with patients with a good grade. CONCLUSIONS:Patients in good clinical condition following aneurysmal SAH but with increasing MTT in the first few days after aneurysmal SAH are at high risk of delayed cerebral ischemia and warrant close clinical monitoring.
Authors: Emanuela Crobeddu; Manoj K Mittal; Stefan Dupont; Eelco F M Wijdicks; Giuseppe Lanzino; Alejandro A Rabinstein Journal: Stroke Date: 2011-12-22 Impact factor: 7.914
Authors: Alfonso Lagares; Marta Cicuendez; Ana Ramos; Elena Salvador; Jose F Alén; Ariel Kaen; Luis Jiménez-Roldán; J M Millán Journal: Acta Neurochir (Wien) Date: 2012-01-12 Impact factor: 2.216
Authors: Michael N Diringer; Thomas P Bleck; J Claude Hemphill; David Menon; Lori Shutter; Paul Vespa; Nicolas Bruder; E Sander Connolly; Giuseppe Citerio; Daryl Gress; Daniel Hänggi; Brian L Hoh; Giuseppe Lanzino; Peter Le Roux; Alejandro Rabinstein; Erich Schmutzhard; Nino Stocchetti; Jose I Suarez; Miriam Treggiari; Ming-Yuan Tseng; Mervyn D I Vergouwen; Stefan Wolf; Gregory Zipfel Journal: Neurocrit Care Date: 2011-09 Impact factor: 3.210
Authors: Daniel Hänggi; Nima Etminan; R Loch Macdonald; Hans Jakob Steiger; Stephan A Mayer; Francois Aldrich; Michael N Diringer; Brian L Hoh; J Mocco; Poul Strange; Herbert J Faleck; Michael Miller Journal: Neurocrit Care Date: 2015-10 Impact factor: 3.210
Authors: Julian Cahill; W Julian Cahill; John W Calvert; John H Calvert; John H Zhang Journal: J Cereb Blood Flow Metab Date: 2006-02-15 Impact factor: 6.200
Authors: D I A Mir; A Gupta; A Dunning; L Puchi; C L Robinson; H-A B Epstein; P C Sanelli Journal: AJNR Am J Neuroradiol Date: 2013-12-05 Impact factor: 3.825
Authors: Ramon Torné; Jhon Hoyos; Laura Llull; Ana Rodríguez-Hernández; Guido Muñoz; Ricard Mellado-Artigas; Daniel Santana; Leire Pedrosa; Alberto Di Somma; Luis San Roman; Sergio Amaro; Joaquim Enseñat Journal: J Clin Med Date: 2021-01-17 Impact factor: 4.241