1
|
Zhou Y, Qian D, Zhou Z, Li B, Ma Y, Chai E. A nomogram for predicting the risk of cerebral vasospasm after neurosurgical clipping in patients with aneurysmal subarachnoid hemorrhage. Front Neurol 2024; 15:1300930. [PMID: 38434203 PMCID: PMC10908552 DOI: 10.3389/fneur.2024.1300930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Cerebral vasospasm (CVS) is a common complication that occurs after neurosurgical clipping of intracranial aneurysms in patients with aSAH. This complication can lead to clinical deterioration and a poor prognosis. The aim of this study is to explore the risk factors for CVS in aSAH patients who have undergone neurosurgical clipping, develop a nomogram for CVS, and evaluate its performance. Methods Patients with aSAH who underwent neurosurgical clipping in the Department of Neurosurgery from January 2018 to January 2023 were selected as the subjects of this research. The clinical data of these patients were retrospectively analyzed. Logistic multivariate regression analysis was employed to identify the independent risk factors of CVS. A clinical prediction model in the form of a nomogram for CVS was developed using the R programming language and subsequently evaluated for its performance and quality. Results A total of 156 patients with aSAH were included in the analysis, comprising 109 patients in the training set and 47 patients in the validation set. In the training cohort, 27 patients (24.77%) developed CVS after neurosurgical clipping, while in the validation cohort, 15 patients (31.91%) experienced CVS. Multivariate regression analysis revealed that age, Hcy, WBC, glucose/potassium ratio, aneurysm location, and modified Fisher grade were independent risk factors for CVS. The nomogram exhibited excellent discriminative performance in both the training set (AUC = 0.885) and the validation set (AUC = 0.906). Conclusion CVS was a prevalent complication following neurosurgical clipping in patients with aSAH, with a highly intricate pathogenesis and pathophysiological course. Early prediction of CVS represented a significant challenge in clinical practice. In this study, age, Hcy, WBC, glucose/potassium ratio, aneurysm location, and modified Fisher grade emerged as independent risk factors for CVS. The resulting nomogram demonstrated substantial predictive value.
Collapse
Affiliation(s)
- Yu Zhou
- First Clinical Medical College, Lanzhou University, Lanzhou, China
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases, Lanzhou, China
| | - Dongliang Qian
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases, Lanzhou, China
| | - Zhou Zhou
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjing, China
- National Clinical Research Center for Chinese Medicine Acquisition and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjing, China
| | - Bin Li
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases, Lanzhou, China
| | - Yong Ma
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases, Lanzhou, China
- Clinical Medicine College, Ningxia Medical University, Yinchuan, China
| | - Erqing Chai
- First Clinical Medical College, Lanzhou University, Lanzhou, China
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases, Lanzhou, China
| |
Collapse
|
3
|
Letourneau-Guillon L, Farzin B, Darsaut TE, Kotowski M, Guilbert F, Chagnon M, Diouf A, Roy D, Weill A, Lemus M, Bard C, Belair M, Landry D, Nico L, Tellier A, Jabre R, Kauffmann C, Raymond J. Reliability of CT Angiography in Cerebral Vasospasm: A Systematic Review of the Literature and an Inter- and Intraobserver Study. AJNR Am J Neuroradiol 2020; 41:612-618. [PMID: 32217551 DOI: 10.3174/ajnr.a6462] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Computed tomography angiography offers a non-invasive alternative to DSA for the assessment of cerebral vasospasm following subarachnoid hemorrhage but there is limited evidence regarding its reliability. Our aim was to perform a systematic review (Part I) and to assess (Part II) the inter- and intraobserver reliability of CTA in the diagnosis of cerebral vasospasm. MATERIALS AND METHODS In Part I, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm (≥ 50% narrowing) and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. Four raters took part in the intraobserver reliability study. RESULTS In Part I, the systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, we found interrater reliability to be moderate at best (κ ≤ 0.6), even when results were stratified according to specialty and experience. Intrarater reliability was substantial (κ > 0.6) in 3/4 readers. In the per arterial segment analysis, substantial agreement was reached only for the middle cerebral arteries, and only when senior raters' judgments were dichotomized (presence or absence of ≥50% narrowing). Agreement on the medical or angiographic management of vasospasm based on CTA alone was less than substantial (κ ≤ 0.6). CONCLUSIONS The diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.
Collapse
Affiliation(s)
- L Letourneau-Guillon
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - B Farzin
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - T E Darsaut
- Department of Surgery (T.E.D.), Division of Neurosurgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - M Kotowski
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - F Guilbert
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - M Chagnon
- Statistical Consultation Services (M.C.), Department of Mathematics and Statistics, Universite de Montreal, Quebec, Canada
| | - A Diouf
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - D Roy
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - A Weill
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - M Lemus
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - C Bard
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - M Belair
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - D Landry
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - L Nico
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - A Tellier
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - R Jabre
- Neurosurgery Division, Surgery Department (R.J.), Centre Hospitalier de l'Universite de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - C Kauffmann
- Laboratoire Clinique du Traitement de l'Image (C.K.), Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - J Raymond
- From the Radiology Department (L.L.-G., B.F., M.K., F.G., A.D., D.R., A.W., M.L., C.B., M.B., D.L., L.N., A.T., J.R.), Centre Hospitalier de l'Universite de Montreal (CHUM), Centre de Recherche du CHUM (CRCHUM), Universite de Montreal, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Li K, Barras CD, Chandra RV, Kok HK, Maingard JT, Carter NS, Russell JH, Lai L, Brooks M, Asadi H. A Review of the Management of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 126:513-527. [PMID: 30898740 DOI: 10.1016/j.wneu.2019.03.083] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysmal subarachnoid hemorrhage. OBJECTIVE To define the scope of the problem and review key treatment strategies that have shaped the way CV is managed in the contemporary era. METHODS A literature search was performed of CV management after aneurysmal subarachnoid hemorrhage. RESULTS Recent advances in neuroimaging have led to improved detection of vasospasm, but established treatment guidelines including hemodynamic augmentation and interventional procedures remain highly variable among neurosurgical centers. Experimental research in subarachnoid hemorrhage continues to identify novel targets for therapy. CONCLUSIONS Proactive and preventive strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV.
Collapse
Affiliation(s)
- Kenny Li
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Christen D Barras
- University of Adelaide, North Terrace Campus, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ronil V Chandra
- Interventional Neuroradiology Service, Monash Health, Clayton, Victoria, Australia
| | - Hong K Kok
- Interventional Radiology Service, Northern Health, Epping, Victoria, Australia
| | - Julian T Maingard
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Victoria, Australia; Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nicole S Carter
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jeremy H Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Leon Lai
- Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia
| | - Mark Brooks
- Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Hamed Asadi
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| |
Collapse
|