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Infarto cerebral retrasado en una hemorragia subaracnoidea de bajo grado. Características, factores predictivos y
Andrea M Alexandre1, Anselmo Caricato2,3, Alessandro Pedicelli1,3
1UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy.
Neurosurgical review
|August 26, 2025
Resumen
El infarto cerebral retardado (IC) en pacientes con hemorragia subaracnoidea aneurysmal de bajo grado (aSAH) se predice por los aneurismas de la arteria comunicante anterior, el volumen de SAH y la necesidad de tratamiento con DSA. El volumen de IC empeora significativamente los resultados, aumentando la discapacidad y la mortalidad.
Área de la Ciencia:
- Neurología
- Neurocirugía
- Radiología
Sus antecedentes:
- La hemorragia subaracnoidea aneurysmal (aSAH) es una condición neurológica crítica.
- Los pacientes con ASA de bajo grado se enfrentan a riesgos significativos, incluido el infarto cerebral retardado (IC).
- Comprender los predictores de CI y su impacto es crucial para mejorar los resultados de los pacientes.
Objetivo del estudio:
- Para identificar los predictores del infarto cerebral retardado (IC) en la AAS de bajo grado.
- Evaluar el impacto clínico de la IC en los resultados de los pacientes.
- Analizar la relación entre el volumen de IC y los resultados de los pacientes.
Principales métodos:
- Análisis retrospectivo de los datos recogidos prospectivamente en el registro POGASH.
- Inclusión de pacientes consecutivos con grados IV-V aSAH de WFNS.
- Definición de IC como nuevas lesiones isquémicas dentro de las 6 semanas, excluyendo las causas relacionadas con el tratamiento.
Principales resultados:
- La IC se produjo en el 19,9% de los 532 pacientes con AAS de bajo grado.
- Los predictores de la IC incluyeron el volumen de SAH, el aneurisma de la arteria comunicante anterior (ACoA) y la necesidad de tratamiento con DSA.
- CI predijo de forma independiente un aumento de la discapacidad (aOR 0, 59).
Conclusiones:
- Los aneurismas de ACoA, el volumen de SAH y el tratamiento con DSA predicen CI en aSAH de bajo grado.
- La extensión volumétrica de la IC es el factor principal de su efecto perjudicial en los resultados.
- El volumen de IC predice de forma independiente la mortalidad y el aumento de la discapacidad en los sobrevivientes.
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