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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Ultraearly hematoma growth in active intracerebral hemorrhage
David Rodriguez-Luna1, Pilar Coscojuela2, Marta Rubiera2
1From the Stroke Unit, Departments of Neurology (D.R.-L., M.R., C.A.M.) and Neuroradiology (P.C., A.T.), Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain; Calgary Stroke Program (M.D.H., A.M.D.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary; Department of Medicine, Neurology (D.D.), and Department of Diagnostic Imaging, Neuroradiology Section (C.L.), The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Canada; Department of Neurology (Y.S.), Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), University of Dresden, Germany; 2nd Department of Neurology (A.C.), Institute of Psychiatry and Neurology of Warsaw, Poland; Charles LeMoyne Hospital (J.-M.B.), University of Sherbrooke, Montreal, Canada; Department of Neurology (C.S.K.), Boston Medical Center, MA; Department of Neurology (G.G.), Dalhousie University, Halifax, Canada; Department of Neurology (R.B., V.P.), All India Institute of Medical Sciences, New Delhi; and AMRI Hospital Kolkata (J.R.), India. rodriguezluna@vhebron.net.
Objective:
To determine the association of ultraearly hematoma growth (uHG) with the CT angiography (CTA) spot sign, hematoma expansion, and clinical outcomes in patients with acute intracerebral hemorrhage (ICH).
Methods:
We analyzed data from 231 patients enrolled in the multicenter Predicting Haematoma Growth and Outcome in Intracerebral Haemorrhage Using Contrast Bolus CT study. uHG was defined as baseline ICH volume/onset-to-CT time (mL/h). The spot sign was used as marker of active hemorrhage. Outcome parameters included significant hematoma expansion (>33% or >6 mL, primary outcome), rate of hematoma expansion, early neurologic deterioration, 90-day mortality, and poor outcome.
Results:
uHG was higher in spot sign patients (p < 0.001) and in patients scanned earlier (p < 0.001). Both uHG >4.7 mL/h (p = 0.002) and the CTA spot sign (p = 0.030) showed effects on rate of hematoma expansion but not its interaction (2-way analysis of variance, p = 0.477). uHG >4.7 mL/h improved the sensitivity of the spot sign in the prediction of significant hematoma expansion (73.9% vs 46.4%), early neurologic deterioration (67.6% vs 35.3%), 90-day mortality (81.6% vs 44.9%), and poor outcome (72.8% vs 29.8%), respectively. uHG was independently related to significant hematoma expansion (odds ratio 1.06, 95% confidence interval 1.03-1.10) and clinical outcomes.
Conclusions:
uHG is a useful predictor of hematoma expansion and poor clinical outcomes in patients with acute ICH. The combination of high uHG and the spot sign is associated with a higher rate of hematoma expansion, highlighting the need for very fast treatment in ICH patients.
