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CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery.

ABSTRACT: To determine whether the CT angiography (CTA) spot sign marks bleeding complications during and after surgery for spontaneous intracerebral hemorrhage (ICH).In a 2-center study of consecutive spontaneous ICH patients who underwent CTA followed by surgical hematoma evacuation, 2 experienced readers (blinded to clinical and surgical data) reviewed CTAs for spot sign presence. Blinded raters assessed active intraoperative and postoperative bleeding. The association between spot sign and active intraoperative bleeding, postoperative rebleeding, and residual ICH volumes was evaluated using univariable and multivariable logistic regression.A total of 95 patients met inclusion criteria: 44 lobar, 17 deep, 33 cerebellar, and 1 brainstem ICH; ?1 spot sign was identified in 32 patients (34%). The spot sign was the only independent marker of active bleeding during surgery (odds ratio [OR] 3.4; 95% confidence interval [CI] 1.3-9.0). Spot sign (OR 4.1; 95% CI 1.1-17), female sex (OR 6.9; 95% CI 1.7-37), and antiplatelet use (OR 4.6; 95% CI 1.2-21) were predictive of postoperative rebleeding. Larger residual hematomas and postoperative rebleeding were associated with higher discharge case fatality (OR 3.4; 95% CI 1.1-11) and a trend toward increased case fatality at 3 months (OR 2.9; 95% CI 0.9-8.8).The CTA spot sign is associated with more intraoperative bleeding, more postoperative rebleeding, and larger residual ICH volumes in patients undergoing hematoma evacuation for spontaneous ICH. The spot sign may therefore be useful to select patients for future surgical trials.

SUBMITTER: Brouwers HB

PROVIDER: S-EPMC4153853 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery.

Brouwers H Bart HB Raffeld Miriam R MR van Nieuwenhuizen Koen M KM Falcone Guido J GJ Ayres Alison M AM McNamara Kristen A KA Schwab Kristin K Romero Javier M JM Velthuis Birgitta K BK Viswanathan Anand A Greenberg Steven M SM Ogilvy Christopher S CS van der Zwan Albert A Rinkel Gabriel J E GJ Goldstein Joshua N JN Klijn Catharina J M CJ Rosand Jonathan J

Neurology 20140806 10

<h4>Objective</h4>To determine whether the CT angiography (CTA) spot sign marks bleeding complications during and after surgery for spontaneous intracerebral hemorrhage (ICH).<h4>Methods</h4>In a 2-center study of consecutive spontaneous ICH patients who underwent CTA followed by surgical hematoma evacuation, 2 experienced readers (blinded to clinical and surgical data) reviewed CTAs for spot sign presence. Blinded raters assessed active intraoperative and postoperative bleeding. The association ...[more]

PMID: 25098540

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Project description:IntroductionSymptomatic intracranial hemorrhage represents one of the most feared complications of endovascular reperfusion. We aim to describe a series of patients that experienced immediate reperfusion injury with active intraprocedural extravasation within the territory of the deep penetrating arteries and provide real-time correlation with CT "spot sign."MethodsThis was a retrospective analysis of patients that suffered reperfusion injury with active arterial extravasation during endovascular stroke treatment in two tertiary care centers.ResultsFive patients were identified. Median age was 63 (58-71) years, 66% were male. Median NIHSS was 13.5 (9.5-23.0), platelet level 212,000 (142,000-235,000), baseline systolic blood pressure 152 (133-201) mm Hg, and non-contrast CT ASPECTS 7.0 (6.5-9.0). Two patients were taking aspirin and one had received intravenous thrombolysis. There were three middle cerebral artery M1, one internal carotid artery terminus, and one vertebrobasilar junction occlusion. Three patients had anterior circulation tandem occlusions. Stroke etiology was extracranial atherosclerosis (n = 2), intracranial atherosclerosis (n = 2), and cervical dissection (n = 1). The median time from onset to puncture was 5.5 (3.9-8.6) h. Intravenous heparin was administered in all patients (median dose of 4,750 [3,250-6,000] units) and intravenous abciximab in four. All tandem cases had the cervical lesion addressed first. Four lenticulostriates and one paramedian pontine artery were involved. Intraprocedural flat-panel CT was performed in four (80%) cases and provided real-time correlation between the active contrast extravasation and the "spot sign." The bailout included use of protamine, blood pressure control, and balloon guide catheter or intracranial compliant balloon inflation plus coiling of targeted vessel. All patients had angiographic cessation of bleeding at the end of the procedure with parenchymal hemorrhage type 1 in one case and type 2 in four. Three patients had modified Rankin score of 4 and two were dead at 90 days.ConclusionsActive reperfusion hemorrhage involving perforator arteries was observed to correlate with the CT "spot sign" and to be associated with poor outcomes.

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CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery.

Publications

CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery.

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