动脉瘤性蛛网膜下腔出血后脑血管痉挛：可卡因使用、Hunt-Hess分级和其他危险因素的影响

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-09-01 Epub Date: 2025-07-28 DOI:10.1007/s00234-025-03713-y

Aliana Rao, Samuel Ricci, Theodore Hannah, Erin Graves, Eric Quach, Kadir Erkmen, Rami Almefty

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引用次数: 0

摘要

脑血管痉挛（CV）是动脉瘤性蛛网膜下腔出血（aSAH）后常见的并发症，其发病率和死亡率都很高。虽然存在许多已确定的心血管危险因素，但非法药物使用的影响，特别是可卡因，仍然存在争议。本研究旨在阐明已知危险因素与心血管发病率、严重程度和难治性之间的关系。方法：回顾性分析2014 - 2023年所有aSAH患者的病历，纳入标准为经数字减影血管造影（DSA）确认动脉瘤及可用尿药筛查（UDS）。收集人口统计学数据、Hunt-Hess （HH）、改良Fisher量表（mFS）、合并症和血管痉挛等级。结果包括血管痉挛治疗计数、住院时间（LOS）和3个月修正Rankin量表（mRS）评分。结果：88例患者中，43%发生CV。可卡因使用在CV组中更为普遍（26% vs. 8%, p = 0.04），且CV风险增加（OR = 4.11, 95% CI: 1.25-16.13, p = 0.03），独立于其他因素。较高的HH分级与CV发生率（OR = 1.75, p = 0.01）、严重程度（β = 0.271, p = 0.02）和3个月mRS评分（β = 0.81, p）增加相关。结论：女性、在UDS中使用可卡因阳性的患者和有T2DM病史的患者CV风险增加，但对严重程度、复发或3个月结局没有影响。年龄越大，长期预后越差。HH等级与血管痉挛严重程度增加、治疗难治性增加以及mRS评分较差的长期预后显著相关。

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Cerebral vasospasm following aneurysmal subarachnoid hemorrhage: the impact of cocaine use, Hunt-Hess grade, and other risk factors.

Introduction: Cerebral vasospasm (CV) is a common complication following aneurysmal subarachnoid hemorrhage (aSAH) that contributes to significant morbidity and mortality. While numerous identified CV risk factors exist, illicit substance use's influence, particularly cocaine, remains controversial. This study aims to elucidate relationships between known risk factors and CV's incidence, severity, and refractoriness.

Methods: A retrospective chart review was conducted on all aSAH patients between 2014 and 2023 with inclusion criteria of confirmed aneurysms on digital subtraction angiography (DSA) and available urine drug screens (UDS). Demographic data, Hunt-Hess (HH), modified Fisher Scale (mFS), comorbidities, and vasospasm grades were collected. Outcomes, including vasospasm treatment counts, length of stay (LOS), and 3-month modified Rankin Scale (mRS) scores, were recorded.

Results: Of 88 patients, 43% experienced CV. Cocaine use was significantly more prevalent in the CV group (26% vs. 8%, p = 0.04) and increased CV risk (OR = 4.11, 95% CI: 1.25-16.13, p = 0.03), independent of other factors. Higher HH grades were associated with increased CV incidence (OR = 1.75, p = 0.01), severity (β = 0.271, p = 0.02), and 3-month mRS scores (β = 0.81, p < 0.001). Female sex also predicted vasospasm incidence (OR = 4.78, p = 0.01). Older age was associated with worse long-term outcomes (β = 0.05, p = 0.004). In the multivariable analysis, cocaine revealed a significant increased risk of CV incidence (OR = 5.79, p = 0.02). Higher HH grades significantly impacted CV severity (OR = 0.30, p = 0.01) and worse long-term outcomes (OR = 0.957, p < 0.01) in the multivariable analysis.

Conclusions: Females, those with positive cocaine use on UDS, and a history of T2DM were at an increased risk of CV with no impact on severity, recurrence, or 3-month outcomes. Older age was associated with worse long-term outcomes. HH grade was significantly associated with increased vasospasm severity, refractoriness to treatment, and worse long-term outcomes as per mRS scores.

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.