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Updated: Oct 17, 2025
A Low Mortality Rat Model to Assess Delayed Cerebral Vasospasm After Experimental Subarachnoid Hemorrhage
Published on: January 17, 2013
The predictive value of the CTA Vasospasm Score on delayed cerebral ischaemia and functional outcome after aneurysmal
J Joep van der Harst1, Gert-Jan R Luijckx1, Jan Willem J Elting1
1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights
The Computed Tomography Angiography Vasospasm Score can predict delayed cerebral ischemia and poor outcomes after subarachnoid hemorrhage. A higher score on day 5 indicates a greater risk for these severe complications.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Delayed cerebral ischemia (DCI) is a serious complication following aneurysmal subarachnoid hemorrhage.
- Cerebral vasospasm is a key factor in the pathophysiology of DCI.
Purpose of the Study:
- To evaluate the predictive value of the Computed Tomography Angiography (CTA) Vasospasm Score for DCI and poor outcomes.
- To determine if the CTA Vasospasm Score can identify patients at high risk for DCI after subarachnoid hemorrhage.
Main Methods:
- A CTA Vasospasm Score was developed, summing vasospasm severity across 17 arterial segments (0-34).
- Outcome measures included cerebral infarction due to DCI (CI-DCI), DCI, and unfavorable functional outcome (modified Rankin Scale >2 at 6 months).
- Receiver operating characteristic (ROC) analyses assessed predictive value, with inter-rater reliability evaluated using Cohen's kappa.
Main Results:
- The study included 59 patients; 14% developed CI-DCI, 24% DCI, and 20% unfavorable outcomes.
- Higher median CTA Vasospasm Scores correlated with increased rates of (CI-)DCI and poor outcomes.
- ROC analysis on day 5 showed the highest area under the curve for CI-DCI (0.89).
Conclusions:
- The CTA Vasospasm Score, particularly on day 5, reliably identifies patients at high risk for DCI and unfavorable outcomes.
- This score serves as a valuable tool for risk stratification in patients post-subarachnoid hemorrhage.
Background And Purpose:
Delayed cerebral ischaemia (DCI) is a severe complication of aneurysmal subarachnoid hemorrhage that can significantly impact clinical outcome. Cerebral vasospasm is part of the pathophysiology of DCI and therefore a computed tomography angiography (CTA) Vasospasm Score was developed and an exploration was carried out of whether this score predicts DCI and subsequent poor outcome after aneurysmal subarachnoid hemorrhage.
Methods:
The CTA Vasospasm Score sums the degree of angiographic cerebral vasospasm of 17 intradural arterial segments. The score ranges from 0 to 34 with a higher score reflecting more severe vasospasm. Outcome measures were cerebral infarction due to DCI (CI-DCI), radiological and clinical DCI, and unfavorable functional outcome defined as a modified Rankin Scale >2 at 6 months. Receiver operating characteristic analyses were used to assess predictive value and to determine optimal cut-off scores. Inter-rater reliability was evaluated by Cohen's kappa coefficient.
Results:
This study included 59 patients. CI-DCI occurred in eight patients (14%), DCI in 14 patients (24%) and unfavorable outcome in 12 patients (20%). Median CTA Vasospasm Scores were higher in patients with (CI-)DCI and poor outcome. Receiver operating characteristic analysis revealed the highest area under the curve on day 5: CI-DCI 0.89 (95% confidence interval [CI] 0.79-0.99), DCI 0.68 (95% CI 0.50-0.87) and functional outcome 0.74 (95% CI 0.57-0.91). Cohen's kappa between the two raters was moderate to substantial (0.57-0.63).
Conclusions:
This study demonstrates that the CTA Vasospasm Score on day 5 can reliably identify patients with a high risk of developing (CI-)DCI and unfavorable outcome.
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