Routine use of perfusion computed tomography for the detection of delayed cerebral ischemia in unconscious patients afte
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ORIGINAL ARTICLE - NEUROSURGICAL INTENSIVE CARE
Routine use of perfusion computed tomography for the detection of delayed cerebral ischemia in unconscious patients after aneurysmal subarachnoid hemorrhage Claudia Ditz 1 & Mathis Hartlieb 1 & Alexander Neumann 2 & Björn Machner 3 & Hannes Schacht 2 & Kara L. Krajewski 4 & Jan Leppert 1 & Volker M. Tronnier 1 & Jan Küchler 1,5 Received: 9 June 2020 / Accepted: 3 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) is difficult to diagnose in unconscious patients, but it is essential for the prognosis. We analyzed the diagnostic value of routinely performed perfusion computed tomography (rPCT) to detect DCI-related hypoperfusion in this subgroup of patients. Methods Retrospective analysis of unconscious aSAH patients who underwent rPCT according to a predefined protocol. We exclusively analyzed PCT examinations in patients who were clinically and functionally asymptomatic with regard to transcranial Doppler ultrasound (TCD) and invasive neuromonitoring at the time of the PCT examination. The perfusion maps were quantitatively evaluated to detect DCI-related hypoperfusion. Possible clinical risk factors for the occurrence of DCI-related hypoperfusion in rPCT imaging were analyzed by multivariate analyses. Results One hundred thirty-six rPCTs were performed in 55 patients. New onset of DCI-related hypoperfusion was observed in 18% of rPCTs. The positive predictive value of rPCT to detect angiographic CVS was 0.80. Between examination days 6 and 10, the rate of DCI-related hypoperfusion was increased significantly (p < 0.05). After rPCT imaging with proof of DCI-related hypoperfusion, short-term follow-up showed secondary cerebral infarction (SCI) in 38%, compared with 5% for patients with normal perfusion on rPCT. The parameters “high risk phase (examination days 6-10)” and “new onset of DCI-related SCI” were significantly associated with the occurrence of DCI-related hypoperfusion in rPCT. Conclusions In unconscious and asymptomatic aSAH patients, rPCT identifies DCI-related hypoperfusion in a relevant number of examinations. However, despite timely endovascular rescue therapy, a significant proportion of secondary infarction still occurs in this subgroup. Keywords Subarachnoid hemorrhage . Cerebral aneurysm . Cerebral vasospasm . Perfusion computed tomography . Delayed cerebral ischemia
Presentation at a conference: 71st Annual Meeting of the German Society of Neurosurgery (DGNC), 8th Joint Meeting with the Japan Neurosurgical Society (JNS), Digital congress 21-24 June 2020. This article is part of the Topical Collection on Neurosurgical intensive care * Jan Küchler [email protected] 1
Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
2
Department of Neuroradiology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
3
Department of Neurology, Universitätsklinikum Sch
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