Quantitative analysis of hemorrhage clearance and delayed cerebral ischemia after subarachnoid hemorrhage.
OBJECTIVE
Initial hemorrhage burden is an independent predictor for delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the association between clot clearance and DCI still remains to be elucidated.


METHODS
Quantitative analysis of hemorrhage volume and clot clearance was made in 116 consecutive patients who were scanned within 24 h from onset. Cisternal plus intraventricular hemorrhage volume (CIHV) was calculated as clot volume from the initial scans and scans performed up to 7 days after onset. Clot clearance was calculated as a percentage of residual clot volume compared with the clot volume on the initial scan. Initial clot volume and clot clearance were dichotomized to evaluate the association with DCI.


RESULTS
Included patients were aged 55.5±15.2 years with a female preponderance (65.5%, (76/116)). The group with higher initial clot volume (≥17.2 mL) had higher odds for DCI (OR 4.3, 95% CI 1.3 to 14.0, p=0.015). However, the rate of DCI was not different between high and low clot clearance groups (26.7% vs 31.0%, p=0.66). Clot clearance rate was similar in patients with and without DCI up to day 7 after onset.


CONCLUSIONS
The quantitative clot clearance rate is not an independent predictor for DCI.
Department of Neurology, Seoul National University Hospital, Seoul, Korea.
Sang-Bae
SB
Ko
Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute, Memorial Hermann of Texas Medical Center, Houston, Texas, USA.
H Alex
HA
Choi
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Raimund
R
Helbok
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
J Michael
JM
Schmidt
Section of Neurocritical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA.
Neeraj
N
Badjatia
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Jan
J
Claassen
Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.
E Sander
ES
Connolly
Departments of Neurology and Neurosurgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Stephan A
SA
Mayer
Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute, Memorial Hermann of Texas Medical Center, Houston, Texas, USA.
Kiwon
K
Lee
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology*; D005069:Evaluation Studies as Topic; D005260:Female; D063285:Fibrin Clot Lysis Time; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*
Aneurysm; Hemorrhage; Stroke; Subarachnoid