Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage

Introduction: Delayed cerebral ischemia (DCI) occurs during a risk period of 3–21 days following aneurysmal subarachnoid hemorrhage (aSAH) and is associated with worse outcomes. The identification of patients at low risk for DCI might permit triage to less intense monitoring and management. While la...

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Autores principales:	Andrew M. Nguyen, Craig A. Williamson, Aditya S. Pandey, Kyle M. Sheehan, Venkatakrishna Rajajee
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	subarachnoid hemorrhage cerebral vasospasm computed tomography angiography cerebral ischemia intracranial aneurysm Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/91431ffd3b8348038964f914f42f0e87
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spelling	oai:doaj.org-article:91431ffd3b8348038964f914f42f0e872021-11-12T05:19:26ZScreening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage1664-229510.3389/fneur.2021.740241https://doaj.org/article/91431ffd3b8348038964f914f42f0e872021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.740241/fullhttps://doaj.org/toc/1664-2295Introduction: Delayed cerebral ischemia (DCI) occurs during a risk period of 3–21 days following aneurysmal subarachnoid hemorrhage (aSAH) and is associated with worse outcomes. The identification of patients at low risk for DCI might permit triage to less intense monitoring and management. While large-vessel vasospasm (LVV) is a distinct clinical entity from DCI, the presence of moderate-to-severe LVV is associated with a higher risk of DCI. Our hypothesis was that the absence of moderate-to-severe LVV on screening computed tomographic angiography (CTA) performed within the first few days of the DCI risk period will accurately identify patients at low risk for subsequent DCI.Methods: This was a retrospective cohort study. Our institutional SAH outcomes registry was queried for all aSAH patients admitted in 2016–2019 who underwent screening CTA brain between days 4 and 8 following ictus. We excluded patients diagnosed with DCI prior to the first CTA performed during this time period. All variables are prospectively entered into the registry, and outcomes including DCI and LVV are prospectively adjudicated. We evaluated the predictive value and accuracy of moderate-to-severe LVV on CTA performed 4–8 days following ictus for the prediction of subsequent DCI.Results: A total of 243 aSAH patients were admitted during the study timeframe. Of the 54 patients meeting the eligibility criteria, 11 (20%) had moderate-to-severe LVV on the screening CTA study performed during the risk period. Seven of the 11 (64%) patients with moderate-to-severe LVV on the days 4–8 screening CTA vs. six of 43 (14%) patients without, subsequently developed DCI. On multivariate analysis, the presence of LVV on days 4–8 screening CTA was an independent predictor of DCI (odds ratio 10.26, 95% CI 1.69–62.24, p = 0.011). NPV for the subsequent development of DCI was 86% (95% CI 77–92%). Sensitivity was 54% (25–81%), specificity 90% (77–97%), and positive predictive value 64% (38–83%).Conclusions: The presence of moderate-to-severe LVV on screening CTA performed between days 4 and 8 following aSAH was an independent predictor of DCI, but achieved only moderate diagnostic accuracy, with NPV 86% and sensitivity 54%. Complementary risk-stratification strategies are likely necessary.Andrew M. NguyenCraig A. WilliamsonCraig A. WilliamsonAditya S. PandeyKyle M. SheehanKyle M. SheehanVenkatakrishna RajajeeVenkatakrishna RajajeeFrontiers Media S.A.articlesubarachnoid hemorrhagecerebral vasospasmcomputed tomography angiographycerebral ischemiaintracranial aneurysmNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	subarachnoid hemorrhage cerebral vasospasm computed tomography angiography cerebral ischemia intracranial aneurysm Neurology. Diseases of the nervous system RC346-429
spellingShingle	subarachnoid hemorrhage cerebral vasospasm computed tomography angiography cerebral ischemia intracranial aneurysm Neurology. Diseases of the nervous system RC346-429 Andrew M. Nguyen Craig A. Williamson Craig A. Williamson Aditya S. Pandey Kyle M. Sheehan Kyle M. Sheehan Venkatakrishna Rajajee Venkatakrishna Rajajee Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
description	Introduction: Delayed cerebral ischemia (DCI) occurs during a risk period of 3–21 days following aneurysmal subarachnoid hemorrhage (aSAH) and is associated with worse outcomes. The identification of patients at low risk for DCI might permit triage to less intense monitoring and management. While large-vessel vasospasm (LVV) is a distinct clinical entity from DCI, the presence of moderate-to-severe LVV is associated with a higher risk of DCI. Our hypothesis was that the absence of moderate-to-severe LVV on screening computed tomographic angiography (CTA) performed within the first few days of the DCI risk period will accurately identify patients at low risk for subsequent DCI.Methods: This was a retrospective cohort study. Our institutional SAH outcomes registry was queried for all aSAH patients admitted in 2016–2019 who underwent screening CTA brain between days 4 and 8 following ictus. We excluded patients diagnosed with DCI prior to the first CTA performed during this time period. All variables are prospectively entered into the registry, and outcomes including DCI and LVV are prospectively adjudicated. We evaluated the predictive value and accuracy of moderate-to-severe LVV on CTA performed 4–8 days following ictus for the prediction of subsequent DCI.Results: A total of 243 aSAH patients were admitted during the study timeframe. Of the 54 patients meeting the eligibility criteria, 11 (20%) had moderate-to-severe LVV on the screening CTA study performed during the risk period. Seven of the 11 (64%) patients with moderate-to-severe LVV on the days 4–8 screening CTA vs. six of 43 (14%) patients without, subsequently developed DCI. On multivariate analysis, the presence of LVV on days 4–8 screening CTA was an independent predictor of DCI (odds ratio 10.26, 95% CI 1.69–62.24, p = 0.011). NPV for the subsequent development of DCI was 86% (95% CI 77–92%). Sensitivity was 54% (25–81%), specificity 90% (77–97%), and positive predictive value 64% (38–83%).Conclusions: The presence of moderate-to-severe LVV on screening CTA performed between days 4 and 8 following aSAH was an independent predictor of DCI, but achieved only moderate diagnostic accuracy, with NPV 86% and sensitivity 54%. Complementary risk-stratification strategies are likely necessary.
format	article
author	Andrew M. Nguyen Craig A. Williamson Craig A. Williamson Aditya S. Pandey Kyle M. Sheehan Kyle M. Sheehan Venkatakrishna Rajajee Venkatakrishna Rajajee
author_facet	Andrew M. Nguyen Craig A. Williamson Craig A. Williamson Aditya S. Pandey Kyle M. Sheehan Kyle M. Sheehan Venkatakrishna Rajajee Venkatakrishna Rajajee
author_sort	Andrew M. Nguyen
title	Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
title_short	Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
title_full	Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
title_fullStr	Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
title_full_unstemmed	Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
title_sort	screening computed tomography angiography to identify patients at low risk for delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/91431ffd3b8348038964f914f42f0e87
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Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage

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