Role of CT Perfusion in Predicting Poor Outcome After Subarachnoid Hemorrhage

Completed

• Conditions: Subarachnoid Hemorrhage; Delayed Cerebral Ischemia; Cerebral Vasospasm

• Registration Number: NCT03214705
• Lead Sponsor: Assiut University

Brief Summary

Prospective evaluation of patients with subarachnoid hemorrhage (SAH) will be done by computed tomography angiography (CTA) and perfusion imaging (CTP) for any correlation between degree of vasospasm and perfusion deficit as well as evaluating the ability of CTP to predict delayed cerebral ischemia.

Detailed Description

Cerebral vasospasm is a serious complication of subarachnoid haemorrhage . In the first 2 weeks of SAH, angiographic vasospasm is seen up to 40-70% of patients and causes ischemic deficits in 15-36% of patients.

The best clinical indicator of significantly reduced brain perfusion (cerebral blood flow (CBF)\<20 ml per 100 g/min) is the presence of new neurologic deficits. However, clinical symptoms may be vague and mimic other conditions in patients with SAH.

CT Perfusion can be used in the evaluation of patients with possible vasospasm after subarachnoid hemorrhage (SAH). It can thus be used to assess cerebral ischemia and infarction as a result of vasospasm after SAH.

The presence of cerebral vasospasm identified with transcranial Doppler, digital subtraction angiography, or CT angiography (CTA) is frequently used to confirm DCI. Presence of vasospasm, however, does not prove the presence of ischemia and absence of vasospasm does not rule out. Better diagnostic tests in the acute stage of deterioration, possibly caused by DCI, are therefore needed. In patients with SAH, CTP has recently been shown to be promising for detection of early ischemia.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2016-03-01
• Study First Submitted: 2017-06-29
• Study First Submitted QC: 2017-07-08
• Study First Posted: 2017-07-11
• Primary Completion: 2018-02-01
• Study Completion: 2018-02-28
• Status Verified: 2021-09
• Last Update Submitted: 2021-09-15
• Last Update Posted: 2021-09-16

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 64

Inclusion Criteria

• All patients presented with subarachnoid haemorrhage

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Exclusion Criteria

• Patients with abnormal renal functions with creatinine ≥ 2 mg/dl/
• Patients with hypersensitivity to contrast media.
• Contraindication to radiation as pregnancy.

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Mean transit time (MTT) on Admission	3 days from the attack	Mean transit time (MTT) on Admission in units of seconds.
Cerebral blood flow (CBF) on Admission	3 days from the attack	Cerebral blood flow (CBF) on Admission in units of ml/100 gram brain tissue/ minute.; The measurements will be compared with the outcome of the patient (namely monitoring delayed cerebral ischemia in SAH patients) to test if early CT perfusion could predict the poor outcome in SAH patients.
Cerebral blood volume (CBV) on Admission	3 days from the attack	Cerebral blood volume (CBF) on Admission in units of ml/100 gram brain tissue.

Secondary Outcome Measures

Name	Time	Method
Correlation of vasospasm to perfusion abnormality using Comparing between CT angiography and CT perfusion in patients with subarachnoid hemorrhage	4-14 days from the attack	Evaluating results of CT angiography and CT perfusion in patients for Correlating vasospasm and perfusion abnormality. Results will be dichotomous; positive and negative, then tested by cross tabulation.
Hunt and Hess scale	3 days from the attack	Hunt and Hess clinical scale was performed for every patient.; Grades are as the following: Grade 1: Asymptomatic or mild headache Grade 2: Cranial nerve palsy or moderate to severe headache/nuchal rigidity Grade 3: Mild focal deficit, lethargy, or confusion Grade 4: Stupor and/or hemiparesis Grade 5: Deep coma, decerebrate posturing, moribund appearance
Fisher scale	3 days from the attack	Fisher scale quantifies the amount of SAH as the following: 1. None evident; 2. Less than 1 mm thick; 3. More than 1 mm thick; 4. Diffuse or none with intraventricular hemorrhage or parenchymal extension

Trial Locations

Locations (1)

Mohamed Abdel-Tawab Mohamed; 🇪🇬 Assiut, Egypt