title: Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage.
abstract: To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).
  
  
  
  From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS).
  
  
  
  A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1-416; p < 0.0001). Patients with a spot sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04-8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU.
  
  
  
  In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative aICH patients.
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Jan-karl.Burkhadt@usz.ch.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Marian Christoph
authors.initials: MC
authors.lastname: Neidert
authors.affiliation: Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.|Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland.
authors.forename: Martin Nikolaus
authors.initials: MN
authors.lastname: Stienen
authors.affiliation: Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schöni
authors.affiliation: Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Fung
authors.affiliation: Department of Neurosurgery, University Clinic Basel, Basel, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Roethlisberger
authors.affiliation: Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland.
authors.forename: Marco Vincenzo
authors.initials: MV
authors.lastname: Corniola
authors.affiliation: Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Bervini
authors.affiliation: Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Maduri
authors.affiliation: Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland.
authors.forename: Daniele
authors.initials: D
authors.lastname: Valsecchi
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Sina
authors.initials: S
authors.lastname: Tok
authors.affiliation: Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany.
authors.forename: Bawarjan
authors.initials: B
authors.lastname: Schatlo
authors.affiliation: Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bijlenga
authors.affiliation: Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bozinov
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Aneurysmal subarachnoid hemorrhage (aSAH); Computed tomography angiography (CTA) spot sign; Intracerebral hemorrhage (ICH); Intraprocedural aneurysma rupture