RT Journal Article SR Electronic T1 Impact of Implementing an Elaborated CT Perfusion Protocol for Aneurysmal SAH on Functional Outcome:
CTP Protocol for SAH JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 1956 OP 1961 DO 10.3174/ajnr.A7279 VO 42 IS 11 A1 V. Malinova A1 K. Döring A1 M.-N. Psychogios A1 V. Rohde A1 D. Mielke YR 2021 UL http://www.ajnr.org/content/42/11/1956.abstract AB BACKGROUND AND PURPOSE: The acute phase of aneurysmal SAH is characterized by a plethora of impending complications with the potential to worsen patients’ outcomes. The aim of this study was to evaluate whether an elaborated CTP-based imaging protocol during the acute aneurysmal SAH phase is able to prevent delayed infarctions and contribute to a better outcome.MATERIALS AND METHODS: In 2012, an elaborated CTP-based protocol was implemented for the management of patients with aneurysmal SAH. Retrospective analysis of patients with aneurysmal SAH treated from 2010 to 2013 was performed, comparing the patients treated before (group one, 2010–2011) with those treated after the protocol implementation (group two, 2012–2013) with regard to delayed infarctions and outcome according to the mRS at 3-months’ follow-up.RESULTS: A total of 133 patients were enrolled, of whom 57 were included in group 1, and 76, in group 2. There were no significant differences between the groups concerning baseline characteristics. In the multivariate analysis, independent predictors of a good outcome (mRS ≤ 2) were younger age (P < .001), lower World Federation of Neurosurgical Societies grade (P < .001), absence of delayed infarction (P = .01), and management according to the CTP protocol (P = .01). Larger or multiple infarctions occurred significantly more often in group 1 compared with group 2 (88% versus 33% of all delayed infarctions, P = .03). The outcome in group 2 was significantly better compared with group 1 (P = .005).CONCLUSIONS: The findings suggest that implementation of an elaborated CTP protocol is associated with a better outcome. An earlier initiation of further diagnostics and treatment with prevention of large territorial and/or multiple infarctions might have led to this finding.aSAHaneurysmal subarachnoid hemorrhageDCIdelayed cerebral ischemiaDINDdelayed ischemic neurologic deficitsERTendovascular rescue therapyTCDtranscranial Doppler sonographyWFNSWorld Federation of Neurosurgical Societies