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Acta Neurochir (Wien). 2017 Jul;159(7):1305-1312. doi: 10.1007/s00701-016-3072-1. Epub 2017 Jan 27.

Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage.

Author information

1
Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Jan-karl.Burkhadt@usz.ch.
2
Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
3
Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
4
Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland.
5
Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
6
Department of Neurosurgery, University Clinic Basel, Basel, Switzerland.
7
Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
8
Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland.
9
Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany.

Abstract

INTRODUCTION:

To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).

METHODS:

From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS).

RESULTS:

A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1-416; p < 0.0001). Patients with a spot sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04-8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU.

CONCLUSION:

In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative aICH patients.

KEYWORDS:

Aneurysmal subarachnoid hemorrhage (aSAH); Computed tomography angiography (CTA) spot sign; Intracerebral hemorrhage (ICH); Intraprocedural aneurysma rupture

PMID:
28127657
DOI:
10.1007/s00701-016-3072-1
[Indexed for MEDLINE]

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