Role of CT Perfusion in Predicting Poor Outcome After Subarachnoid Hemorrhage
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|ClinicalTrials.gov Identifier: NCT03214705|
Recruitment Status : Completed
First Posted : July 11, 2017
Last Update Posted : September 6, 2018
|Condition or disease|
|Subarachnoid Hemorrhage Cerebral Vasospasm Delayed Cerebral Ischemia|
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.
|Study Type :||Observational [Patient Registry]|
|Actual Enrollment :||64 participants|
|Target Follow-Up Duration:||21 Days|
|Official Title:||Role of Computed Tomography Perfusion in Detection of Patients at Risk for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage|
|Actual Study Start Date :||March 1, 2016|
|Actual Primary Completion Date :||February 1, 2018|
|Actual Study Completion Date :||February 28, 2018|
Patients with poor outcome
Follow up of patients is done for 21 days by combined clinical and radiological examination. Poor clinical outcome is associated with vasospasm leading to permanent neurological deficit, stroke or death.
Patients without poor outcome
Patients who do not develop delayed cerebral ischemia or stroke, confirmed by combined clinical and radiological examination.
- Cerebral blood flow (CBF) on Admission [ Time Frame: 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 [ Time Frame: 3 days from the attack ]Cerebral blood volume (CBF) on Admission in units of ml/100 gram brain tissue.
- Mean transit time (MTT) on Admission [ Time Frame: 3 days from the attack ]Mean transit time (MTT) on Admission in units of seconds.
- Correlation of vasospasm to perfusion abnormality using Comparing between CT angiography and CT perfusion in patients with subarachnoid hemorrhage [ Time Frame: 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 [ Time Frame: 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 [ Time Frame: 3 days from the attack ]
Fisher scale quantifies the amount of SAH as the following:
- None evident
- Less than 1 mm thick
- More than 1 mm thick
- Diffuse or none with intraventricular hemorrhage or parenchymal extension
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03214705
|Mohamed Abdel-Tawab Mohamed|
|Assiut, Egypt, 71511|
|Principal Investigator:||Mohamed Abdel-Tawab||Assiut University|
|Study Chair:||Afaf A. Hasan, Profosser||Assiut University|
|Study Director:||Mohamed A. Ahmed, Professor||Assiut University|
|Study Director:||Hany M. Seif, Professor||Assiut University|
|Study Director:||Hazem A. Youssef, Professor||Assiut unviersity|