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Impact of Stereotactic Ventriculocisternostomy on Delayed Cerebral Infarction and Outcome After Subarachnoid Hemorrhage.
Roelz, Roland; Schaefer, Jan Hendrik; Scheiwe, Christian; Sajonz, Bastian; Csok, Istvan; Steiert, Christine; Buttler, Jürgen; Rohr, Eva; Grauvogel, Jürgen; Shah, Mukesch J; Egger, Karl; Niesen, Wolf-Dirk; Bardutzky, Jürgen; Beck, Jürgen; Coenen, Volker A; Reinacher, Peter C.
  • Roelz R; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Schaefer JH; Department of Neurology, Goethe-University Frankfurt, Germany (J.H.S.).
  • Scheiwe C; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Sajonz B; Department of Stereotactic and Functional Neurosurgery (B.S., V.A.C., P.C.R.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Csok I; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Steiert C; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Buttler J; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Rohr E; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Grauvogel J; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Shah MJ; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Egger K; Department of Neuroradiology (K.E.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Niesen WD; Department of Neurology (W.-D.N., J. Bardutzky), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Bardutzky J; Department of Neurology (W.-D.N., J. Bardutzky), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Beck J; From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Coenen VA; Department of Stereotactic and Functional Neurosurgery (B.S., V.A.C., P.C.R.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Reinacher PC; Department of Stereotactic and Functional Neurosurgery (B.S., V.A.C., P.C.R.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Stroke ; 51(2): 431-439, 2020 02.
Article en En | MEDLINE | ID: mdl-31795898
ABSTRACT
Background and Purpose- Delayed cerebral infarction (DCI) is an important cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage is a new method for DCI prevention. Here, we assess the effects of implementing STX-VCS in an unselected aSAH patient population of a tertiary referral center. Methods- Retrospective cohort study of all consecutive aSAH patients admitted to a neurosurgical referral center during a 7-year period (April 2012 to April 2019). Midterm STX-VCS was introduced and offered to patients at high risk for DCI. We compared the incidence and burden of DCI, neurological outcome, and the use of induced hypertension and endovascular rescue therapy in this consecutive aSAH population 3.5 years before versus 3.5 years after STX-VCS became available. Results- Four hundred thirty-six consecutive patients were included 222 BEFORE and 214 AFTER. Fifty-seven of 214 (27%) patients received STX-VCS. Stereotactic procedures resulted in one (2%) subdural hematoma. Favorable neurological outcome at 6 months occurred in 118 (53%) patients BEFORE and 139 (65%) patients AFTER (relative risk, 0.79 [95% CI, 0.66-0.95]). DCI occurred in 40 (18.0%) patients BEFORE and 17 (7.9%) patients AFTER (relative risk, 0.68 [95% CI, 0.57-0.86]), and total DCI volumes were 8933 (100%) and 3329 mL (36%), respectively. Induced hypertension was used in 97 (44%) and 30 (15%) patients, respectively (relative risk, 0.55 [95% CI, 0.46-0.65]). Thirty (13.5%) patients BEFORE versus 5 (2.3%) patients AFTER underwent endovascular rescue therapies (relative risk, 0.17 [95% CI, 0.07-0.42]). Conclusions- Selecting high-risk patients for STX-VCS reduced the DCI incidence, burden, and related mortality in a consecutive aSAH patient population. This was associated with an improved neurological outcome.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Hemorragia Subaracnoidea / Vasodilatadores / Ventriculostomía / Infarto Cerebral / Fibrinolíticos Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2020 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Search on Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Hemorragia Subaracnoidea / Vasodilatadores / Ventriculostomía / Infarto Cerebral / Fibrinolíticos Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2020 Tipo del documento: Article