Dissociation of Early and Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage.
Cerebral infarction after aneurysmal subarachnoid hemorrhage is a significant cause of substantial morbidity and mortality. Because early and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage may be mediated by different processes, we evaluated whether aneurysm-securing methods contributed to infarcts and whether long-term outcomes differ between early and delayed infarcts.



A post hoc analysis of the CONSCIOUS-1 study (Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage) was performed. Using multivariate logistic regression analysis and propensity matching, independent clinical risk factors associated with infarctions were identified, and the contribution of cerebral infarcts to long-term outcomes was evaluated.



Within the cohort of 413 subjects, early infarcts were present in 76 subjects (18%), whereas delayed infarcts occurred in 79 subjects (19%), and 36 subjects (9%) had new infarctions that were present on both early and delayed imaging. Propensity score matching revealed a significantly higher proportion of early infarcts after clipping (odds ratio, 4.62; 95% confidence interval, 1.99-11.57; P=0.00012). Multivariate logistic regressions identified clipping as an independent risk factor for early cerebral infarction (odds ratio, 0.26; 95% confidence interval, 0.15-0.48; P<0.001), and angiographic vasospasm was an independent risk factor for delayed cerebral infarction (odds ratio, 1.79; 95% confidence interval, 1.03-3.13; P=0.039). Early infarcts were a significant independent risk factor for poor long-term outcomes at 3 months (odds ratio, 2.34; 95% confidence interval, 1.18-4.67; P=0.015).



Clipping is an independent risk factor for the development of early cerebral infarcts, whereas delayed cerebral infarcts are associated with angiographic vasospasm. Early cerebral infarcts are stronger predictors of worse outcome than delayed infarction.



URL: http://www.clinicaltrials.gov. Unique identifier: NCT00111085.
From the Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada (O.G.S.A., G.M.I., N.M.A., R.L.M.); and Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada (O.G.S.A., P.A.G). oliver.ayling@alumni.ubc.ca.
Oliver G S
OG
Ayling
From the Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada (O.G.S.A., G.M.I., N.M.A., R.L.M.); and Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada (O.G.S.A., P.A.G).
George M
GM
Ibrahim
From the Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada (O.G.S.A., G.M.I., N.M.A., R.L.M.); and Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada (O.G.S.A., P.A.G).
Naif M
NM
Alotaibi
From the Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada (O.G.S.A., G.M.I., N.M.A., R.L.M.); and Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada (O.G.S.A., P.A.G).
Peter A
PA
Gooderham
From the Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada (O.G.S.A., G.M.I., N.M.A., R.L.M.); and Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada (O.G.S.A., P.A.G).
R Loch
RL
Macdonald
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000453:epidemiology; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology
algorithms; angiography; cerebral infarction; risk factors; subarachnoid hemorrhage