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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(03): 157-165
DOI: 10.1055/s-0039-1692124
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Angiographic Findings in Refractory Delayed Cerebral Ischemia

Achados angiográficos na isquemia cerebral tardia refratária
Nicolás González 
1   Department of Neurosurgery, Hospital Regional Rancagua, Rancagua, Chile
,
Alvaro Ruiz
2   Department of Neurosurgery, Institute of Neurosurgery Asenjo, Santiago, Chile
,
Jorge Mura
2   Department of Neurosurgery, Institute of Neurosurgery Asenjo, Santiago, Chile
› Author Affiliations Source of Funding None.
Further Information

Publication History

29 December 2018

17 April 2019

Publication Date:
31 May 2019 (online)

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Abstract

Background Delayed cerebral ischemia (DCI) follows a refractory course in a subgroup of patients with aneurysmal subarachnoid hemorrhage (SAH), leading to diffuse ischemic injury. The role of angiographic vasospasm (AV) is unknown. Our goal is to study the angiographic alterations and the clinical profile of refractory DCI patients.

Methods Retrospective study of patients with SAH who presented with DCI treated with medical and endovascular therapy, with a refractory evolution, defined as multiple ischemic infarction and brain death.

Results Out of a cohort of 336 patients, 7 (2%) developed refractory DCI. The median age of the patients was 48 (38–60) years old. Five patients had ruptured anterior communicating artery (ACoA) aneurysms. Four patients were treated with coil embolization, and three with microsurgical clipping. Angiographic vasospasm was classified as severe in 5 cases. Compromise of bilateral circulation was detected in six patients. Distal circulation vasospasm occurred in five cases. Slow circulatory transit times were observed in three patients.

Conclusion Angiographic findings such as bilateral circulatory compromise and distal vasospasm were frequent alterations. Further studies are required to establish the association of these findings with the clinical outcomes.

Resumo

Introdução A isquemia cerebral tardia (ICT) pode seguir um curso refratário em um subgrupo de pacientes com hemorragia subaracnoidea aneurismática (HSA), levando a uma lesão isquêmica difusa. O papel do vasoespasmo angiográfico (VA) ainda é desconhecido. Nosso objetivo é avaliar as alterações angiográficas e o perfil clínico dos pacientes com ICT refratária.

Métodos Estudo retrospectivo de pacientes com HSA que apresentaram ICT tratados com terapia médica e endovascular, com evolução refratária, definida como infarto isquêmico múltiplo e morte cerebral.

Resultados A partir de uma coorte de 336 pacientes, 7 (2%) desenvolveram ICT refratária. A mediana de idade foi de 48 (38–60) anos. Cinco pacientes tiveram ruptura de aneurisma da artéria comunicante anterior (ACoA). Quatro pacientes foram tratados com coiling e três com clipagem. O VA foi classificado como grave em cinco casos. Detectou-se acometimento da circulação bilateral em seis pacientes. A circulação distal do vasoespasmo aconteceu em cinco casos. Observou-se tempo de trânsito circulatório lento em três pacientes.

Conclusão Os achados angiográficos, como o acometimento circulatório bilateral e o vasoespasmo distal, foram alterações frequentes. Estudos adicionais serão necessários para confirmar as associações entre os achados angiográficos e os resultados clínicos.

Keywords

subarachnoid hemorrhage - intracranial vasospasm - brain ischemia - angioplasty

Palavras-chave

hemorragia subaracnoidea - vasoespasmo intracraniano - isquemia cerebral - angioplastia

Disclosure

None.


 

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