• J Joep van der Harst, Gert-Jan R Luijckx, EltingJan Willem JJWJDepartment of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Thijs Lammers, BokkersReinoud P HRPHDepartment of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Walter M van den Bergh, Omid S Eshghi, MetzemaekersJan D MJDMDepartment of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., GroenRob J MRJMDepartment of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Aryan Mazuri, VeegerNic J G MNJGMDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., van DijkJ Marc CJMChttps://orcid.org/0000-0002-0814-5680Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., and Maarten Uyttenboogaart.
• Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
• Eur. J. Neurol. 2021 Oct 13.

Background And PurposeDelayed 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.MethodsThe 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.ResultsThis 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).ConclusionsThis 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.© 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

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