1
|
Li X, Du H, Li J, Chen X. Intracranial artery calcification as an independent predictor of ischemic stroke: a systematic review and a meta-analysis. BMC Neurol 2023; 23:21. [PMID: 36647035 PMCID: PMC9841662 DOI: 10.1186/s12883-023-03069-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND PURPOSE The association between intracranial artery calcification (IAC) and the risk of ischemic stroke occurrence or poor prognosis had not yet been fully understood. In this study, we conducted a meta-analysis of existing studies aimed to assess whether IAC can be used to predict future ischemic stroke and post-stroke mortality. METHODS Medline, Cochrane, Web of Science and Google Scholar databases were searched up to June 30, 2022. Studies were included if they reported risk ratio (RR) or odds ratios (OR) and corresponding 95% confidence intervals (CI) of stroke concerning the presence of IAC. Random or fixed effects model meta-analyses were performed. Meta-analysis was conducted by using Stata version 16.0. RESULTS Twelve studies involving 9346 participants were included. Compared with those without IAC, patients with IAC had a higher risk of stroke occurrence (adjusted OR 1.62, 95% CI 1.18-2.23, P = 0.001) and stroke recurrence (adjusted OR 1.77, 95% CI 1.25-2.51, P = 0.003). However, we did not find a significant correlation between IAC and post-stroke mortality (pooled OR 1.12, 95% CI 0.80-1.56, P = 0.504). CONCLUSIONS Our meta-analysis demonstrated that the presence of IAC was identified as an independent risk factor for ischemic stroke occurrence and recurrence but is not a predictor of post-stroke mortality.
Collapse
Affiliation(s)
- Xuelong Li
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Heng Du
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jia Li
- grid.33199.310000 0004 0368 7223Department of Neurology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xiangyan Chen
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| |
Collapse
|
2
|
Krzyżewski RM, Kliś KM, Kwinta BM, Łasocha B, Brzegowy P, Popiela TJ, Gąsowski J. Subarachnoid Hemorrhage from Ruptured Internal Carotid Artery Aneurysm: Association with Arterial Tortuosity. World Neurosurg 2022; 166:e84-e92. [PMID: 35811029 DOI: 10.1016/j.wneu.2022.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture. METHODS We retrospectively analyzed the internal carotid artery anatomy of 149 patients with internal carotid artery aneurysms. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). RESULTS A total of 33 patients (22.15%) had subarachnoid hemorrhage. These patients had significantly lower SOAM (0.31 ± 0.17 vs. 0.42 ± 0.21; P < 0.01), TI (0.27 ± 0.09 vs. 0.31 ± 0.11; P = 0.03) and ICM (0.25 ± 0.11 vs. 0.31 ± 0.17; P = 0.04). In multivariate logistic regression analysis, higher SOAM (odds ratio, 0.780; 95% confidence interval, 0.619-0.961; P = 0.025) remained independently associated with lower risk of internal carotid artery aneurysm rupture. In addition, we found significant positive correlation of aneurysm dome size with SOAM (R = 0.224; P = 0.013) and PAD (0.269; P < 0.01). Our study also showed that age (R = 0.252; P = 0.036), Glasgow Coma Scale score (R = -0.706; P < 0.01), and TI (R = -0.249; P = 0.042) were independently correlated with modified Rankin Scale score on discharge. CONCLUSIONS Lower tortuosity might be a protective factor against internal carotid artery aneurysm rupture and poor outcome after subarachnoid hemorrhage. Higher tortuosity is correlated with internal carotid artery aneurysm growth.
Collapse
Affiliation(s)
- Roger M Krzyżewski
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland.
| | - Kornelia M Kliś
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Borys M Kwinta
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Departments of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
3
|
Fote GM, Raefsky S, Mock K, Chaudhari A, Shafie M, Yu W. Intracranial Arterial Calcifications: Potential Biomarkers of Stroke Risk and Outcome. Front Neurol 2022; 13:900579. [PMID: 36119671 PMCID: PMC9475140 DOI: 10.3389/fneur.2022.900579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Intracranial artery calcifications (IAC), a common and easily identifiable finding on computed tomorgraphy angiography (CTA), has gained recognition as a possible risk factor for ischemic stroke. While atherosclerosis of intracranial arteries is believed to be a mechanism that commonly contributes to ischemic stroke, and coronary artery calcification is well-established as a predictor of both myocardial infarction (MI) and ischemic stroke risk, IAC is not currently used as a prognostic tool for stroke risk or recurrence. This review examines the pathophysiology and prevalence of IAC, and current evidence suggesting that IAC may be a useful tool for prediction of stroke incidence, recurrence, and response to acute ischemic stroke therapy.
Collapse
Affiliation(s)
- Gianna M. Fote
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Sophia Raefsky
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Kelton Mock
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Amit Chaudhari
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Amit Chaudhari
| | - Mohammad Shafie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
4
|
Cisternal irrigation and clot removal to prevent vasospasm and poor outcome in aneurysmal subarachnoid hemorrhage: Systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
5
|
Du H, Yang W, Chen X. Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease. Front Neurol 2022; 12:789035. [PMID: 35140673 PMCID: PMC8818681 DOI: 10.3389/fneur.2021.789035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial artery calcification (IAC) was regarded as a proxy for intracranial atherosclerosis (ICAS). IAC could be easily detected on routine computer tomography (CT), which was neglected by clinicians in the previous years. The evolution of advanced imaging technologies, especially vessel wall scanning using high resolution-magnetic resonance imaging (HR-MRI), has aroused the interest of researchers to further explore the characteristics and clinical impacts of IAC. Recent histological evidence acquired from the human cerebral artery specimens demonstrated that IAC could mainly involve two layers: the intima and the media. Accumulating evidence from histological and clinical imaging studies verified that intimal calcification is more associated with ICAS, while medial calcification, especially the internal elastic lamina, contributes to arterial stiffness rather than ICAS. Considering the highly improved abilities of novel imaging technologies in differentiating intimal and medial calcification within the large intracranial arteries, this review aimed to describe the histological and imaging features of two types of IAC, as well as the risk factors, the hemodynamic influences, and other clinical impacts of IAC occurring in intimal or media layers.
Collapse
Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Xiangyan Chen
| |
Collapse
|
6
|
Goertz L, Kabbasch C, Styczen H, Timmer M, Laukamp K, Pennig L, Maus V, Grunz JP, Brinker G, Goldbrunner R, Krischek B. Impact of aneurysm morphology on aneurysmal subarachnoid hemorrhage severity, cerebral infarction and functional outcome. J Clin Neurosci 2021; 89:343-348. [PMID: 34119291 DOI: 10.1016/j.jocn.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/22/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity. The objective was to evaluate, whether specific morphological aneurysm characteristics could serve as predictive values for aSAH severity, disease-related complications and clinical outcome. METHODS A total of 453 aSAH patients (mean age: 54.9 ± 13.8 years, mean aneurysm size: 7.5 ± 3.6 mm) treated at a single center were retrospectively included. A morphometric analysis was performed based on angiographic image sets, determining aneurysm location, aneurysm size, neck width, aneurysm size ratios, aneurysm morphology and vessel size. The following outcome measures were defined: World Federation of Neurosurgical Societies (WFNS) grade 4 and 5, Fisher grade 4, vasospasm, cerebral infarction and unfavorable functional outcome. RESULTS Regarding morphology parameters, aneurysm neck width was an independent predictor for Fisher 4 hemorrhage (OR: 1.1, 95%CI: 1.0-1.3, p = 0.048), while dome width (OR: 0.92, 95%CI: 0.86-0.97, p = 0.005) and internal carotid artery location (OR: 2.1, 95%CI: 1.1-4.2, p = 0.028) predicted vasospasm. None of the analyzed morphological characteristics prognosticated functional outcome. Patient age (OR: 0.95, 95%CI: 0.93-0.96, p < 0.001), WFNS score (OR: 4.8, 95%CI: 2.9-8.0, p < 0.001), Fisher score (OR: 2.3, 95%CI: 1.4-3.7, p < 0.001) and cerebral infarction (OR: 4.5, 95%CI: 2.7-7.8, p < 0.001) were independently associated with unfavorable outcome. CONCLUSIONS The findings indicate a correlation between aneurysm morphology, Fisher grade and vasospasm. Further studies will be required to reveal an independent association of aneurysm morphology with cerebral infarction and functional outcome.
Collapse
Affiliation(s)
- Lukas Goertz
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Christoph Kabbasch
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Marco Timmer
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Kai Laukamp
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Lenhard Pennig
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, In der Schornau 23-25, 44892 Bochum, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Boris Krischek
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Department of Neurosurgery, Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540, Luxembourg
| |
Collapse
|
7
|
Colip CG, Wo S, Hippe DS, Watase H, Urdaneta-Moncada AR, Zhu C, Wu L, Vranic JE, Kelly CM, Levitt MR, Mossa-Basha M. Computed tomography angiography findings predictive of post-intervention vasospasm in patients with aneurysmal subarachnoid hemorrhage. Br J Radiol 2021; 94:20200893. [PMID: 33661704 DOI: 10.1259/bjr.20200893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the association of CT/CT angiography (CTA) findings and clinical characteristics with subsequent vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS- Consecutive presentation CTA head exams in patients with aSAH between January 2005 and June 2015 were retrospectively evaluated for intracranial arterial calcification, undulation and non-calcified stenosis. Additional variables including modified Fisher Scale (mFS), Glasgow Coma Scale (GCS) and neurological exam status were reviewed. Associations of CTA findings with the incidence of angiographic vasospasm were assessed with multivariate logistic regression models using the least absolute shrinkage and selection operator machine-learning algorithm. Model performance was summarized using c-index with bootstrap optimism-adjustment. RESULTS Intracranial arterial calcification, seen in 51.7% of 195 total patients, was protective against vasospasm (OR-0.6; 95% CI-0.52-0.67; p = 0.009), while arterial undulation (24%) was associated with subsequent vasospasm (OR-2.6; 95% CI-1.3-5.1; p = 0.007). Non-calcified intracranial arterial stenosis (5%) was associated with subsequent vasospasm, (OR-4.7; 95% CI-1.0-22.8; p = 0.054). Least absolute shrinkage and selection operator selected all three CTA findings as predictors in a multivariate model for vasospasm in addition to clinical factors, which demonstrated superior predictive performance (c-index-0.74; 95% CI-0.69-0.82) compared to a model based on mFS and clinical factors only (c-index-0.66; 95% CI-0.57-0.75; p = 0.010 for the difference). CONCLUSION Presentation CTA findings combined with clinical factors may better predict the development of vasospasm in patients with aSAH compared to current prognostic models alone. ADVANCES IN KNOWLEDGE The combination of initial CT/CTA and clinical findings better predict development of vasospasm after aSAH. This can lead to better markers for use in future clinical trials to develop vasospasm preventative treatments and potentially provide better targets for early aggressive treatment.
Collapse
Affiliation(s)
- Charles G Colip
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sean Wo
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Lei Wu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Justin E Vranic
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Cory M Kelly
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA.,Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA.,Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
8
|
Bartstra JW, van den Beukel TC, Van Hecke W, Mali WPTM, Spiering W, Koek HL, Hendrikse J, de Jong PA, den Harder AM. Intracranial Arterial Calcification: Prevalence, Risk Factors, and Consequences: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 76:1595-1604. [PMID: 32972537 DOI: 10.1016/j.jacc.2020.07.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Abstract
Intracranial large and small arterial calcifications are a common incidental finding on computed tomography imaging in the general population. Here we provide an overview of the published reports on prevalence of intracranial arterial calcifications on computed tomography imaging and histopathology in relation to risk factors and clinical outcomes. We performed a systematic search in Medline, with a search filter using synonyms for computed tomography scanning, (histo)pathology, different intracranial arterial beds, and calcification. We found that intracranial calcifications are a frequent finding in all arterial beds with the highest prevalence in the intracranial internal carotid artery. In general, prevalence increases with age. Longitudinal studies on calcification progression and intervention studies are warranted to investigate the possible causal role of calcification on clinical outcomes. This might open up new therapeutic directions in stroke and dementia prevention and the maintenance of the healthy brain.
Collapse
Affiliation(s)
- Jonas W Bartstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Tim C van den Beukel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wim Van Hecke
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Annemarie M den Harder
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
9
|
Kim SM, Jung IM, Kim D, Lee JP, So YH. Effect of Inflow Arterial Calcification on Arteriovenous Fistula Maturation. Ann Vasc Surg 2019; 58:331-337. [PMID: 30769062 DOI: 10.1016/j.avsg.2018.10.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study is to investigate the effect of preexisting calcification in the inflow artery on maturation and flow volume of an arteriovenous fistula (AVF). METHODS Patients who underwent AVF creation for hemodialysis were prospectively recruited between March and November 2017. On preoperative duplex ultrasound, calcification in the arterial media within 5 cm of the planned anastomosis area was assessed. Clinical maturation was defined as the successful use of the fistula for ≥75% of the dialysis sessions during a month within 6 months after surgery. Radiological maturation was defined as a venous diameter of ≥0.4 cm and a flow volume of ≥500 mL/min. Flow volumes of the inflow artery and the cephalic vein were measured at 6 and 12 weeks after AVF creation. RESULTS Eighteen patients with calcification and 29 patients without calcification were enrolled in this study. There was no significant difference in the clinical and radiological maturation between the groups. The flow volume of the inflow artery, measured at 6 weeks postoperatively, was significantly higher in the noncalcification group than in the calcification group (P = 0.042). The flow volume of the inflow artery in the noncalcification group was increased at 12 weeks postoperatively (P = 0.091). Flow volume of the vein was higher in the noncalcification group than in the calcification group, although it did not reach statistical significance. CONCLUSIONS In conclusions, preexisting arterial calcification did not adversely affect the AVF maturation. However, arterial calcification correlated with the flow volume of the inflow artery of AVF.
Collapse
Affiliation(s)
- Suh Min Kim
- Department of Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - In Mok Jung
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
| | - Daehwan Kim
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jung Pyo Lee
- Department of Internal medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Young Ho So
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| |
Collapse
|
10
|
Matsukawa H, Miyazaki T, Kiko K, Kamiyama H, Ota N, Noda K, Takahashi O, Shonai T, Fujisawa T, Tokuda S, Tanikawa R. Thick Clot in the Inferior Limiting Sulcus on Computed Tomography Image as an Indicator of Sylvian Subpial Hematoma in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 125:e612-e619. [PMID: 30716497 DOI: 10.1016/j.wneu.2019.01.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Sylvian subpial hematoma (SSH) is occasionally observed in aneurysm subarachnoid hemorrhage (aSAH) when accompanied with the thick clot in the inferior limiting sulcus (ILS). We aimed to determine whether the thickness of the clot in the ILS (TCILS) was an indicator of SSH. METHODS Data from 150 consecutive patients with aSAH were retrospectively analyzed. The relationship between TCILS on axial computed tomography (CT) image and intraoperatively confirmed SSH was reviewed. In patients without SSH, the average of the clot thickness in the bilateral ILS was used. The primary outcome was SSH. RESULTS The median TCILS of the SSH group (n = 18, 12%) was larger than that of the non-SSH group (n = 132, 88%) (21 vs. 2.1 mm, respectively; P < 0.001). The intraclass correlation coefficients for clot thickness in the right and left ILS between 2 observers were 0.97 (P < 0.001) and 0.85 (P < 0.001). The TCILS threshold of ≥6.0 mm was associated with SSH, with a sensitivity of 89% and specificity of 99%. The unadjusted and adjusted odds ratios of the SSH of clot thickness in the affected ILS ≥6 mm relative to clot thickness in the affected ILS <6 mm were 263 (95% confidence interval [CI], 46-5063) and 137 (95% CI, 19-3029), respectively. CONCLUSIONS The clot thickness in the ILS on CT image was easily measured and could be a marker of SSH. SSH assessment could be useful in helping us predict the clinical course in patients with aSAH.
Collapse
Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Katsunari Kiko
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- St.Luke's International University Graduate School of Public Health, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Takaharu Shonai
- Department of Radiology, Teishinkai Hospital, Sapporo, Japan
| | | | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| |
Collapse
|
11
|
Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Suzuki G, Takeda R, Tokuda S. Effects of Clot Removal by Meticulous Irrigation and Continuous Low-Dose Intravenous Nicardipine on Symptomatic Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage Treated by Clipping. World Neurosurg 2015; 84:1798-803. [PMID: 26278868 DOI: 10.1016/j.wneu.2015.07.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/26/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Symptomatic cerebral vasospasm (SCV) is the second most common of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH) after rebleeding. Blood breakdown products are one of the leading causes of vasospasm. We hypothesized that meticulous subarachnoid clot removal in addition to continuous low-dose intravenous nicardipine (CLIN) could reduce the incidence of SCV. METHODS SCV was defined as new focal neurologic signs, consciousness deterioration, or both when the cause was believed to be ischemia attributable to vasospasm after other possible causes of worsening were excluded. Initial brain damage was defined as continued consciousness disturbance after clipping without acute hydrocephalus, ischemic lesions, or focal sign before clipping. Poor outcome was defined as a Glasgow Outcome Scale score of 3-5 at 30 days. We compared the variables for 460 aSAH patients with and without SCV, and with and without poor outcome by multivariate analysis. RESULTS All patients underwent clipping with meticulous irrigation for clot removal, and SCV was observed in 56 patients (12%). SCV was observed in 2 patients (2.9%) among 70 patients treated with CLIN. There was a higher proportion of patients who were older than 65 years (P = 0.032) and female (P = 0.038), and a lower proportion of patients with CLIN (P = 0.026) among patients with SCV. The outcomes for 109 patients (27%) were poor; age greater than 65 years (P < 0.0001) and initial brain damage (P = 0.008) were related to the poor outcomes. CONCLUSIONS The present study showed that meticulous irrigation for clot removal and CLIN might reduce the incidence of SCV in patients with aSAH.
Collapse
Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Go Suzuki
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rihei Takeda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| |
Collapse
|