title: Clot-clearance rate in the sylvian cistern is associated with the severity of cerebral vasospasm after subarachnoid hemorrhage.
abstract: Rapid clot removal and clearance has been proposed as an effective tool for preventing cerebral vasospasm after subarachnoid hemorrhage (SAH). We examined the relationship between clot-clearance rate and the severity of cerebral vasospasm in 110 consecutive patients with aneurysmal SAH. We measured clot-clearance rates per day in the basal and Sylvian cisterns, and evaluated the presence of symptomatic vasospasm based on changes in clinical symptoms and the appearance of a new low-density area on a computed tomography (CT) scan. The severity of symptomatic cerebral vasospasm was associated with age and the SAH grade on admission; however, we observed no significant difference between these variables in patients with urokinase irrigation or fasudil hydrochloride treatment. The mean clot-clearance rates per day for patients with asymptomatic and permanent delayed ischemic neurological deficit were 41.9 and 41.5 %, respectively, in the basal cistern (P = 0.7358) and 37.7 and 23.9 %, respectively, in the Sylvian cistern (P = 0.0021). The reduced clot-clearance rate in the Sylvian cistern increased the risk of vasospasm-related infarction (P = 0.0093) and markedly reduced unfavorable outcomes (P = 0.0115).
authors.affiliation: Department of Neurosurgery, JCHO Tokyo Shinjuku Medical Center, 5-1 Tsukudocho Shinjuku, Tokyo, 162-8543, Japan, ttoyoda-tky@umin.net.
authors.forename: Tomikatsu
authors.initials: T
authors.lastname: Toyoda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yonekura
authors.forename: Akira
authors.initials: A
authors.lastname: Iijima
authors.forename: Munehisa
authors.initials: M
authors.lastname: Shinozaki
authors.forename: Takeo
authors.initials: T
authors.lastname: Tanishima
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D013346:Subarachnoid Space; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging