Delayed Cerebral Infarction is Systematically Associated with a Cerebral Vasospasm of Large Intracranial Arteries
Delayed Cerebral Infarction is Systematically Associated with a Cerebral Vasospasm of Large Intracranial Arteries
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DOI：
10.1093/neuros/nyz340
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发表时间：
2020-02-01
期刊：
影响因子：
4.8
通讯作者：
Labeyrie, Marc-Antoine
中科院分区：
文献类型：
--
作者：
Brami, Jonathan;Chousterman, Benjamin;Labeyrie, Marc-Antoine
背景蛛网膜下腔出血（aSAH）后迟发性脑梗死（DCIn）是否由大动脉痉挛引起仍有争议。目的通过定量评估远侧动脉痉挛随时间和区域的变化，研究DCIn与血管痉挛的关系。方法回顾性分析2012年至2017年在我中心接受治疗的392例aSAH患者的临床和影像学资料。DCIn定义为发作后3 ~ 21 d内发生的任何脑梗死，且与其他特定原因无关。在DCIn患者中，在DCIn周围24小时内评估每个脑动脉的血管痉挛，直至第2段结束。DCIn和血管痉挛分析是盲法的。结果DCIn在11%的患者中被发现（评分者间k = 0.90，计算机断层扫描（CT）扫描= 100%，随访MRI = 91%）。在258个动脉区域中对血管痉挛进行定量，包括66个有DCIn和192个无DCIn（DSA = 93%，计算机断层扫描血管造影= 7%）。DCIn区的血管痉挛比非DCIn区严重（60% [55-69] vs 20% [0-50]，P <0.001）。血管痉挛与DCIn呈“剂量依赖性”相关（趋势P = 0.022）。每个DCIn区域的血管痉挛>= 50%，包括仅39%的远端动脉段。只有9%的非DCIn领土的血管痉挛>=血管痉挛在DCIn territors.CONCLUSION严重的血管痉挛和DCIn在我们的研究之间的必要关联带来了额外的参数，有利于大动脉血管痉挛（特别是远段）作为一个主要的决定因素DCIn和潜在的治疗目标。
BACKGROUND Whether delayed cerebral infarction (DCIn) after aneurysmal subarachnoid hemorrhage (aSAH) is driven by large artery vasospasm is still controversial.OBJECTIVE To study the association between DCIn and vasospasm by using quantitative assessment of vasospasm up to distal arteries with time and territorial-based correlation.METHODS Clinical and imaging data of 392 patients with aSAH treated at our center between 2012 and 2017 were reviewed. DCIn was defined as any cerebral infarction occurring within 3 to 21 d after ictus and not related to other specific cause. In patients with DCIn, vasospasm was assessed within 24 h around DCIn for each cerebral artery up to the end of the 2nd segments. DCIn and vasospasm analyses were blinded.RESULTS DCIn was found in 11% of patients (inter-rater k = 0.90, computed tomography (CT)-scan = 100%, follow-up MRI = 91%). Vasospasm was quantified in 258 artery territories including 66 with and 192 without DCIn (DSA = 93%, computed tomography angiography = 7%). Vasospasm was more severe in DCIn than in non-DCIn territories (60% [55-69] vs 20% [0-50], P < .001). Vasospasm was associated with DCIn in a "dose-dependent" manner (P for trend = .022). Every DCIn territory had a vasospasm >= 50%, including 39% only of distal artery segments. Only 9% of non-DCIn territories had vasospasm >= vasospasm in DCIn territories.CONCLUSION The necessary association between severe vasospasm and DCIn in our study brings additional arguments in favor of large artery vasospasm (especially of distal segments) as a major determinant of DCIn and a potential therapeutic target.