Predictors of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage with Asymptomatic Angiographic Vasospasm on Admission

Abdulrahman Aldakkan; Alireza Mansouri; Blessing N R Jaja; Naif M. Alotaibi; R. Loch Macdonald; Adam Noble; Andrew Molyneux; Audrey Quinn; Bawarjan Schatlo; Benjamin Lo; Blessing N R Jaja; Clay Johnston; Daniel Hanggi; David Hasan; George K C Wong; Hector Lantigua; Hitoshi Fukuda; James Torner; Jeff Singh; Julian Spears; Karl Schaller; Martin N. Stienen; Mervyn D I Vergouwen; Michael D. Cusimano; Michael Todd; Ming Tseng; Peter Le Roux; R. Loch Macdonald; Sen Yamagata; Stephan Mayer; Thomas Schenk; Tom A. Schweizer

doi:10.1016/j.wneu.2016.09.096

Predictors of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage with Asymptomatic Angiographic Vasospasm on Admission

Abdulrahman Aldakkan, Alireza Mansouri, Blessing N R Jaja, Naif M. Alotaibi, R. Loch Macdonald, Adam Noble, Andrew Molyneux, Audrey Quinn, Bawarjan Schatlo, Benjamin Lo, Blessing N R Jaja, Clay Johnston, Daniel Hanggi, David Hasan, George K C Wong, Hector Lantigua, Hitoshi Fukuda, James Torner, Jeff Singh, Julian SpearsKarl Schaller, Martin N. Stienen, Mervyn D I Vergouwen, Michael D. Cusimano, Michael Todd, Ming Tseng, Peter Le Roux, R. Loch Macdonald, Sen Yamagata, Stephan Mayer, Thomas Schenk, Tom A. Schweizer

Anesthesiology

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Background Risk of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) with asymptomatic angiographic vasospasm on admission is unclear in the literature. The goal of this study is to identify predictors of clinical DCI in this group of patients. Methods An exploratory subgroup analysis was conducted in the SAHIT (Subarachnoid Hemorrhage International Trialists) data repository to identify predictors of clinical DCI in patients with good-grade aSAH (World Federation of Neurological Surgeons grade I and II) with angiographic vasospasm on admission. Predictors considered include age, sex, systolic blood pressure at presentation, World Federation of Neurological Surgeon grade, Fisher grade, aneurysm size and location, treatment modality, hydrocephalus requiring external ventricular drain insertion, and severity of vasospasm. The predictors were ranked based on dominance analysis with R² as fit statistics and assessed in a set of logistic regression analysis models. Results Four data sets out of 16 studies in the SAHIT database were analyzed, with a total of 4125 patients. One hundred and ninety-one patients (4.6%) had asymptomatic angiographic vasospasm at admission. Of those, 78 patients (40.8%) developed clinical DCI. Univariate analysis showed significant associations between severe vasospasm on admission and development of clinical DCI (odds ratio, 9.5, 95% confidence interval, 2.07–43.50; P = 0.004). None of the studied predictors was associated with the development of clinical DCI on multivariate analysis. Conclusions Asymptomatic angiographic vasospasm in patients with good-grade aSAH on admission is uncommon. Further studies are needed to identify high-risk patients for the development of DCI in the context of asymptomatic early vasospasm.

Original language	English (US)
Pages (from-to)	199-204
Number of pages	6
Journal	World neurosurgery
Volume	97
DOIs	https://doi.org/10.1016/j.wneu.2016.09.096
State	Published - Jan 1 2017

Bibliographical note

Funding Information:
The SAHIT Collaborators: Adam Noble, Ph.D. (King's College, London, United Kingdom); Andrew Molyneux, M.D. (Oxford University, Oxford, United Kingdom); Audrey Quinn, M.D. (The General Infirmary, Leeds, United Kingdom), Bawarjan Schatlo, M.D. (Department of Neurosurgery, University Hospital Göttingen, Germany); Benjamin Lo, M.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Blessing N. R. Jaja, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Clay Johnston, M.D. (University of California, San Francisco, California, USA); Daniel Hanggi, M.D. (Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany); David Hasan, M.D. (University of Iowa, Iowa, USA); George K. C. Wong, M.D. (Chinese University of Hong Kong, Hong Kong, China); Hector Lantigua, M.D. (Columbia University, New York, USA); Hitoshi Fukuda, M.D. (Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan); James Torner, Ph.D. (University of Iowa, Iowa, USA); Jeff Singh, M.D. (Toronto Western Hospital, University of Toronto, Toronto, Canada); Julian Spears, M.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Karl Schaller, M.D. (Service de Neurochirurgie, Département de Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland); Martin N. Stienen, M.D. (Service de Neurochirurgie, Département de Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland); Mervyn D. I. Vergouwen, M.D., Ph.D. (University Medical Center Utrecht, Utrecht, The Netherlands); Michael D. Cusimano, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Michael Todd, M.D. (University of Iowa, Iowa, USA); Ming Tseng, M.D. (Medicines and Healthcare Products Regulatory Agency); Peter Le Roux, M.D. (Jefferson University, Pennsylvania, Philadelphia, USA); R. Loch Macdonald, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Sen Yamagata, M.D. (Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan); Stephan Mayer, M.D. (Icahn School of Medicine at Mount Sinai, New York, USA); Thomas Schenk, Ph.D. (King's College, London, United Kingdom); Tom A. Schweizer, Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada).

Publisher Copyright:
© 2016 Elsevier Inc.

Keywords

Aneurysmal subarachnoid hemorrhage
Delayed cerebral ischemia
Vasospasm

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10.1016/j.wneu.2016.09.096

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Aldakkan, A., Mansouri, A., Jaja, B. N. R., Alotaibi, N. M., Macdonald, R. L., Noble, A., Molyneux, A., Quinn, A., Schatlo, B., Lo, B., Jaja, B. N. R., Johnston, C., Hanggi, D., Hasan, D., Wong, G. K. C., Lantigua, H., Fukuda, H., Torner, J., Singh, J., ... Schweizer, T. A. (2017). Predictors of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage with Asymptomatic Angiographic Vasospasm on Admission. World neurosurgery, 97, 199-204. https://doi.org/10.1016/j.wneu.2016.09.096

Aldakkan, A, Mansouri, A, Jaja, BNR, Alotaibi, NM, Macdonald, RL, Noble, A, Molyneux, A, Quinn, A, Schatlo, B, Lo, B, Jaja, BNR, Johnston, C, Hanggi, D, Hasan, D, Wong, GKC, Lantigua, H, Fukuda, H, Torner, J, Singh, J, Spears, J, Schaller, K, Stienen, MN, Vergouwen, MDI, Cusimano, MD, Todd, M, Tseng, M, Le Roux, P, Macdonald, RL, Yamagata, S, Mayer, S, Schenk, T & Schweizer, TA 2017, 'Predictors of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage with Asymptomatic Angiographic Vasospasm on Admission', World neurosurgery, vol. 97, pp. 199-204. https://doi.org/10.1016/j.wneu.2016.09.096

@article{1409a929750d4c6ca3883cdd1c985c6f,

title = "Predictors of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage with Asymptomatic Angiographic Vasospasm on Admission",

abstract = "Background Risk of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) with asymptomatic angiographic vasospasm on admission is unclear in the literature. The goal of this study is to identify predictors of clinical DCI in this group of patients. Methods An exploratory subgroup analysis was conducted in the SAHIT (Subarachnoid Hemorrhage International Trialists) data repository to identify predictors of clinical DCI in patients with good-grade aSAH (World Federation of Neurological Surgeons grade I and II) with angiographic vasospasm on admission. Predictors considered include age, sex, systolic blood pressure at presentation, World Federation of Neurological Surgeon grade, Fisher grade, aneurysm size and location, treatment modality, hydrocephalus requiring external ventricular drain insertion, and severity of vasospasm. The predictors were ranked based on dominance analysis with R2 as fit statistics and assessed in a set of logistic regression analysis models. Results Four data sets out of 16 studies in the SAHIT database were analyzed, with a total of 4125 patients. One hundred and ninety-one patients (4.6%) had asymptomatic angiographic vasospasm at admission. Of those, 78 patients (40.8%) developed clinical DCI. Univariate analysis showed significant associations between severe vasospasm on admission and development of clinical DCI (odds ratio, 9.5, 95% confidence interval, 2.07–43.50; P = 0.004). None of the studied predictors was associated with the development of clinical DCI on multivariate analysis. Conclusions Asymptomatic angiographic vasospasm in patients with good-grade aSAH on admission is uncommon. Further studies are needed to identify high-risk patients for the development of DCI in the context of asymptomatic early vasospasm.",

keywords = "Aneurysmal subarachnoid hemorrhage, Delayed cerebral ischemia, Vasospasm",

author = "Abdulrahman Aldakkan and Alireza Mansouri and Jaja, {Blessing N R} and Alotaibi, {Naif M.} and Macdonald, {R. Loch} and Adam Noble and Andrew Molyneux and Audrey Quinn and Bawarjan Schatlo and Benjamin Lo and Jaja, {Blessing N R} and Clay Johnston and Daniel Hanggi and David Hasan and Wong, {George K C} and Hector Lantigua and Hitoshi Fukuda and James Torner and Jeff Singh and Julian Spears and Karl Schaller and Stienen, {Martin N.} and Vergouwen, {Mervyn D I} and Cusimano, {Michael D.} and Michael Todd and Ming Tseng and {Le Roux}, Peter and Macdonald, {R. Loch} and Sen Yamagata and Stephan Mayer and Thomas Schenk and Schweizer, {Tom A.}",

note = "Funding Information: The SAHIT Collaborators: Adam Noble, Ph.D. (King's College, London, United Kingdom); Andrew Molyneux, M.D. (Oxford University, Oxford, United Kingdom); Audrey Quinn, M.D. (The General Infirmary, Leeds, United Kingdom), Bawarjan Schatlo, M.D. (Department of Neurosurgery, University Hospital G{\"o}ttingen, Germany); Benjamin Lo, M.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Blessing N. R. Jaja, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Clay Johnston, M.D. (University of California, San Francisco, California, USA); Daniel Hanggi, M.D. (Department of Neurosurgery, Medical Faculty Heinrich Heine University, D{\"u}sseldorf, Germany); David Hasan, M.D. (University of Iowa, Iowa, USA); George K. C. Wong, M.D. (Chinese University of Hong Kong, Hong Kong, China); Hector Lantigua, M.D. (Columbia University, New York, USA); Hitoshi Fukuda, M.D. (Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan); James Torner, Ph.D. (University of Iowa, Iowa, USA); Jeff Singh, M.D. (Toronto Western Hospital, University of Toronto, Toronto, Canada); Julian Spears, M.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Karl Schaller, M.D. (Service de Neurochirurgie, D{\'e}partement de Neurosciences Cliniques, H{\^o}pitaux Universitaires de Gen{\`e}ve, Geneva, Switzerland); Martin N. Stienen, M.D. (Service de Neurochirurgie, D{\'e}partement de Neurosciences Cliniques, H{\^o}pitaux Universitaires de Gen{\`e}ve, Geneva, Switzerland); Mervyn D. I. Vergouwen, M.D., Ph.D. (University Medical Center Utrecht, Utrecht, The Netherlands); Michael D. Cusimano, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Michael Todd, M.D. (University of Iowa, Iowa, USA); Ming Tseng, M.D. (Medicines and Healthcare Products Regulatory Agency); Peter Le Roux, M.D. (Jefferson University, Pennsylvania, Philadelphia, USA); R. Loch Macdonald, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Sen Yamagata, M.D. (Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan); Stephan Mayer, M.D. (Icahn School of Medicine at Mount Sinai, New York, USA); Thomas Schenk, Ph.D. (King's College, London, United Kingdom); Tom A. Schweizer, Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada). Publisher Copyright: {\textcopyright} 2016 Elsevier Inc.",

year = "2017",

month = jan,

day = "1",

doi = "10.1016/j.wneu.2016.09.096",

language = "English (US)",

volume = "97",

pages = "199--204",

journal = "World Neurosurgery",

issn = "1878-8750",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Predictors of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage with Asymptomatic Angiographic Vasospasm on Admission

AU - Aldakkan, Abdulrahman

AU - Mansouri, Alireza

AU - Jaja, Blessing N R

AU - Alotaibi, Naif M.

AU - Macdonald, R. Loch

AU - Noble, Adam

AU - Molyneux, Andrew

AU - Quinn, Audrey

AU - Schatlo, Bawarjan

AU - Lo, Benjamin

AU - Jaja, Blessing N R

AU - Johnston, Clay

AU - Hanggi, Daniel

AU - Hasan, David

AU - Wong, George K C

AU - Lantigua, Hector

AU - Fukuda, Hitoshi

AU - Torner, James

AU - Singh, Jeff

AU - Spears, Julian

AU - Schaller, Karl

AU - Stienen, Martin N.

AU - Vergouwen, Mervyn D I

AU - Cusimano, Michael D.

AU - Todd, Michael

AU - Tseng, Ming

AU - Le Roux, Peter

AU - Macdonald, R. Loch

AU - Yamagata, Sen

AU - Mayer, Stephan

AU - Schenk, Thomas

AU - Schweizer, Tom A.

N1 - Funding Information: The SAHIT Collaborators: Adam Noble, Ph.D. (King's College, London, United Kingdom); Andrew Molyneux, M.D. (Oxford University, Oxford, United Kingdom); Audrey Quinn, M.D. (The General Infirmary, Leeds, United Kingdom), Bawarjan Schatlo, M.D. (Department of Neurosurgery, University Hospital Göttingen, Germany); Benjamin Lo, M.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Blessing N. R. Jaja, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Clay Johnston, M.D. (University of California, San Francisco, California, USA); Daniel Hanggi, M.D. (Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany); David Hasan, M.D. (University of Iowa, Iowa, USA); George K. C. Wong, M.D. (Chinese University of Hong Kong, Hong Kong, China); Hector Lantigua, M.D. (Columbia University, New York, USA); Hitoshi Fukuda, M.D. (Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan); James Torner, Ph.D. (University of Iowa, Iowa, USA); Jeff Singh, M.D. (Toronto Western Hospital, University of Toronto, Toronto, Canada); Julian Spears, M.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Karl Schaller, M.D. (Service de Neurochirurgie, Département de Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland); Martin N. Stienen, M.D. (Service de Neurochirurgie, Département de Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland); Mervyn D. I. Vergouwen, M.D., Ph.D. (University Medical Center Utrecht, Utrecht, The Netherlands); Michael D. Cusimano, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Michael Todd, M.D. (University of Iowa, Iowa, USA); Ming Tseng, M.D. (Medicines and Healthcare Products Regulatory Agency); Peter Le Roux, M.D. (Jefferson University, Pennsylvania, Philadelphia, USA); R. Loch Macdonald, M.D., Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada); Sen Yamagata, M.D. (Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan); Stephan Mayer, M.D. (Icahn School of Medicine at Mount Sinai, New York, USA); Thomas Schenk, Ph.D. (King's College, London, United Kingdom); Tom A. Schweizer, Ph.D. (St. Michael's Hospital, University of Toronto, Toronto, Canada). Publisher Copyright: © 2016 Elsevier Inc.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background Risk of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) with asymptomatic angiographic vasospasm on admission is unclear in the literature. The goal of this study is to identify predictors of clinical DCI in this group of patients. Methods An exploratory subgroup analysis was conducted in the SAHIT (Subarachnoid Hemorrhage International Trialists) data repository to identify predictors of clinical DCI in patients with good-grade aSAH (World Federation of Neurological Surgeons grade I and II) with angiographic vasospasm on admission. Predictors considered include age, sex, systolic blood pressure at presentation, World Federation of Neurological Surgeon grade, Fisher grade, aneurysm size and location, treatment modality, hydrocephalus requiring external ventricular drain insertion, and severity of vasospasm. The predictors were ranked based on dominance analysis with R2 as fit statistics and assessed in a set of logistic regression analysis models. Results Four data sets out of 16 studies in the SAHIT database were analyzed, with a total of 4125 patients. One hundred and ninety-one patients (4.6%) had asymptomatic angiographic vasospasm at admission. Of those, 78 patients (40.8%) developed clinical DCI. Univariate analysis showed significant associations between severe vasospasm on admission and development of clinical DCI (odds ratio, 9.5, 95% confidence interval, 2.07–43.50; P = 0.004). None of the studied predictors was associated with the development of clinical DCI on multivariate analysis. Conclusions Asymptomatic angiographic vasospasm in patients with good-grade aSAH on admission is uncommon. Further studies are needed to identify high-risk patients for the development of DCI in the context of asymptomatic early vasospasm.

AB - Background Risk of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) with asymptomatic angiographic vasospasm on admission is unclear in the literature. The goal of this study is to identify predictors of clinical DCI in this group of patients. Methods An exploratory subgroup analysis was conducted in the SAHIT (Subarachnoid Hemorrhage International Trialists) data repository to identify predictors of clinical DCI in patients with good-grade aSAH (World Federation of Neurological Surgeons grade I and II) with angiographic vasospasm on admission. Predictors considered include age, sex, systolic blood pressure at presentation, World Federation of Neurological Surgeon grade, Fisher grade, aneurysm size and location, treatment modality, hydrocephalus requiring external ventricular drain insertion, and severity of vasospasm. The predictors were ranked based on dominance analysis with R2 as fit statistics and assessed in a set of logistic regression analysis models. Results Four data sets out of 16 studies in the SAHIT database were analyzed, with a total of 4125 patients. One hundred and ninety-one patients (4.6%) had asymptomatic angiographic vasospasm at admission. Of those, 78 patients (40.8%) developed clinical DCI. Univariate analysis showed significant associations between severe vasospasm on admission and development of clinical DCI (odds ratio, 9.5, 95% confidence interval, 2.07–43.50; P = 0.004). None of the studied predictors was associated with the development of clinical DCI on multivariate analysis. Conclusions Asymptomatic angiographic vasospasm in patients with good-grade aSAH on admission is uncommon. Further studies are needed to identify high-risk patients for the development of DCI in the context of asymptomatic early vasospasm.

KW - Aneurysmal subarachnoid hemorrhage

KW - Delayed cerebral ischemia

KW - Vasospasm

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Predictors of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage with Asymptomatic Angiographic Vasospasm on Admission

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