Angiographic Vasospasm Is Strongly Correlated With Cerebral Infarction After Subarachnoid Hemorrhage
Angiographic Vasospasm Is Strongly Correlated With Cerebral Infarction After Subarachnoid Hemorrhage
复制标题
DOI：
10.1161/strokeaha.110.597005
复制
发表时间：
2011-04-01
期刊：
影响因子：
8.3
通讯作者：
Macdonald, R. Loch
中科院分区：
文献类型：
--
作者：
Crowley, R. Webster;Medel, R.;Macdonald, R. Loch
背景和目的：长期以来认为蛛网膜下腔出血后迟发性脑梗死完全由大动脉血管痉挛引起的观点最近受到了挑战。我们使用CONSCIOUS-1试验的数据来确定蛛网膜下腔出血后血管造影性血管痉挛和脑梗死之间的关系。方法我们对CONSCIOUS-1试验的数据进行了事后探索性分析。所有患者在治疗前和蛛网膜下腔出血后9 +/- 2天接受导管血管造影。在动脉瘤治疗前后和蛛网膜下腔出血后6周进行CT检查。通过集中设盲审查评估血管造影和CT扫描。血管造影血管痉挛分为无/轻度（动脉直径减小0%-33%）、中度（34%-66%）或重度（>= 67%）。栓塞被归类为继发于血管造影性血管痉挛、其他或未知原因。Logistic回归分析，以确定相关因素与infarct.Results-Complete数据为381 413例（92%）。209例（55%）患者的血管造影性血管痉挛为无/轻度，118例（31%）为中度，54例（14%）为重度。209例无/轻度血管痉挛患者中有6例（3%）发生痉挛，118例中度血管痉挛患者中有12例（10%）发生痉挛，54例重度血管痉挛患者中有25例（46%）发生痉挛。多变量分析发现血管造影性血管痉挛与脑梗死之间存在强相关性（OR，9.3; 95%CI，3.7-23.4）。在调整入院神经系统分级和动脉瘤大小后，这种显著相关性仍然存在。动脉瘤的治疗方法与梗死发生率无显著差异。结论血管造影性血管痉挛与脑梗死之间存在强相关性。努力进一步减少血管造影性血管痉挛是必要的。（中风。2011;42：919-923）。
Background and Purpose-The long-standing concept that delayed cerebral infarction after aneurysmal subarachnoid hemorrhage results exclusively from large artery vasospasm recently has been challenged. We used data from the CONSCIOUS-1 trial to determine the relationship between angiographic vasospasm and cerebral infarction after subarachnoid hemorrhage.Methods-We performed a post hoc exploratory analysis of the CONSCIOUS-1 data. All patients underwent catheter angiography before treatment and 9 +/- 2 days after subarachnoid hemorrhage. CT was performed before and after aneurysm treatment, and 6 weeks after subarachnoid hemorrhage. Angiograms and CT scans were assessed by centralized blinded review. Angiographic vasospasm was classified as none/mild (0%-33% decrease in arterial diameter), moderate (34%-66%), or severe (>= 67%). Infarctions were categorized as secondary to angiographic vasospasm, other, or unknown causes. Logistic regression was conducted to determine factors associated with infarction.Results-Complete data were available for 381 of 413 patients (92%). Angiographic vasospasm was none/mild in 209 (55%) patients, moderate in 118 (31%), and severe in 54 (14%). Infarcts developed in 6 (3%) of 209 with no/mild, 12 (10%) of 118 patients with moderate, and 25 (46%) of 54 patients with severe vasospasm. Multivariate analysis found a strong association between angiographic vasospasm and cerebral infarction (OR, 9.3; 95% CI, 3.7-23.4). The significant association persisted after adjusting for admission neurological grade and aneurysm size. Method of aneurysm treatment was not associated with a significant difference in frequency of infarction.Conclusions-A strong association exists between angiographic vasospasm and cerebral infarction. Efforts directed at further reducing angiographic vasospasm are warranted. (Stroke. 2011;42:919-923.)