Deep venous drainage variant rate and degree may be higher in patients with perimesencephalic than in non-perimesencephalic angiogram-negative subarachnoid hemorrhage
Deep venous drainage variant rate and degree may be higher in patients with perimesencephalic than in non-perimesencephalic angiogram-negative subarachnoid hemorrhage
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中脑周围出血患者的深静脉引流变异率和程度可能高于非中脑周围血管造影阴性蛛网膜下腔出血患者
DOI：
10.1007/s00330-020-07242-5
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发表时间：
2020-09-11
影响因子：
5.9
通讯作者：
Zhang, Jianmin
中科院分区：
文献类型：
--
作者：
Fang, Yuanjian;Shao, Anwen;Zhang, Jianmin
基底静脉变异（BVR）是血管造影阴性的蛛网膜下腔出血（AN-SAH）的潜在出血源。我们比较了中脑周围型AN-SAH（PAN-SAH）和非中脑周围型AN-SAH（NPAN-SAH）患者的BVR变异率和程度。分析了变量（基线特征、临床和影像学数据以及结局）与出血模式和BVR变异程度之间的相关性。此外，潜在的预测积极的结果，重复数字减影血管造影（DSA），再出血，迟发性脑梗死（DCI），和不良的结果进行了进一步study.ResultsA共273例AN-SAH。PAN-SAH患者BVR变异的发生率和程度明显高于NPAN-SAH患者（p< 0.001）。双侧BVR正常的患者更可能有严重的预后和弥散的血液分布（p< 0.05）。我们发现双侧BVR正常的患者在出院后3个月和1年时重复DSA、DCI、再出血和预后不良的阳性发现率增加（均P < 0.05）。双侧BVR正常是重复DSA阳性、再出血和预后不良的危险因素（P < 0.05）。双侧BVR正常的AN-SAH患者更可能是动脉出血，有再出血的风险，预后差。关键点·与NPAN-SAH患者相比，PAN-SAH患者BVR变异的发生率和程度更高，这表明BVR正常的AN-SAH患者更可能起源于动脉出血。·BVR正常的AN-SAH患者更可能在重复DSA检查中有阳性结果，以及再出血和不良结局的发生率增加，这可能有助于指导神经科医生选择治疗方案。
ObjectivesThe basal vein of Rosenthal (BVR) variant is a potential origin of bleeding in angiogram-negative subarachnoid hemorrhage (AN-SAH). We compared the rate and degree of BVR variants in patients with perimesencephalic AN-SAH (PAN-SAH) and non-perimesencephalic AN-SAH (NPAN-SAH).MethodsWe retrospectively reviewed the records of AN-SAH patients admitted to our hospital between 2013 and 2018. The associations between variables (baseline characteristics, clinical and radiological data, and outcome) with bleeding patterns and degree of BVR variants were analyzed. Additionally, potential predictors of positive findings on repeated digital-subtracted angiogram (DSA), rebleeding, delayed cerebral infarction (DCI), and poor outcome were further studied.ResultsA total of 273 patients with AN-SAH were included. The incidence rate and degree of BVR variants were significantly higher in PAN-SAH patients compared with those in NPAN-SAH patients (p< 0.001). Patients with normal bilateral BVRs are more likely to have a severe prognosis and diffused blood distribution (p< 0.05). We found an increased rate of positive findings on repeated DSA, DCI, rebleeding, and poor outcome at 3 months and 1 year after discharge (allp< 0.05) in patients with bilateral normal BVRs. Bilateral normal BVRs were considered a risk factor (predictor) of positive findings on repeated DSA, rebleeding, and poor outcome (allp< 0.05).ConclusionsPAN-SAH patients have a higher rate and degree of BVR variants compared with patients with NPAN-SAH. Those AN-SAH patients with bilateral normal BVRs are more likely to be of arterial origin and are at risk of suffering from rebleeding and a poor outcome.Key Points• Patients with PAN-SAH have a higher rate and degree of BVR variants compared with patients with NPAN-SAH, which suggested that AN-SAH patients with normal BVRs are more likely to originate from arterial bleeding.• AN-SAH patients with normal BVRs are more likely to have positive findings on repeated DSA examinations, as well as an increased incidence of rebleeding and poor outcome, which may assist and guide neurologists in selecting treatment.