AN INTEGRATED MODEL FOR EARLY DIAGNOSING DELAYED CEREBRAL ISCHEMIA IN

PATIENTS WITH NONTRAUMATIC SUBARACHNOID HEMORRHAGE DUE TO INTRACRANIAL ANEURYSM RUPTURE

 

Sementsova O.V.

 

N.V. Sklifosovsky Research Institute of Emergency Medicine. Moscow, Russia.

Purpose. To conduct a quantitative analysis of the parameters of complex radiological neuromonitoring and to establish threshold values for early reliable prediction of delayed cerebral ischemia (DCI) in the early acute phase after non-traumatic subarachnoid hemorrhage (ntSAH).

Materials and Methods. This prospective single-center study enrolled 60 patients in the acute phase of ntSAH caused by ruptured intracranial aneurysms. All patients underwent comprehensive radiological neuromonitoring at three time points (on admission, after surgical intervention, and after another 7 days): CT perfusion (CTP) with assessment of CBV, CBF, MTT, Tmax, TTP; transcranial doppler (TCD) of cerebral vessels with calculation of the Lindegaard Index (LI); and CT angiography (CTA) of intracranial arteries with measurement of the diameters of the middle cerebral artery (MCA) segments. Statistical analysis was performed to identify predictors of DCI.

Results. DCI was diagnosed in 27 patients (45%). The most significant prognostic parameters identified post-operatively were: a decrease in CBV≤2,1 ml/100g (OR=13,8), CBF≤28,5 ml/100g/min (OR=9,3), an increase in MTT>5,0 s (OR=7,6), and an increase in the LI >3,0 on the side ipsilateral to the ruptured aneurysm (OR=7,8). In the postoperative period, dynamic changes within the same patient between studies, specifically a decrease in CBV and CBF and an increase in MTT, were also significant predictors of DCI (OR ranging from 4,48 to 8,0). A combined model for the early diagnosis of DCI was derived, incorporating CBV≤2,11 ml/100g, LI>3,0, and the emergence of neurological deficits over time. This model demonstrated high predictive accuracy (AUC=0,916).

Conclusions. A comprehensive assessment of radiological data (cranial CTP, TCD, CTA), neurological status, and their dynamic changes in the early postoperative period allows for highly accurate prediction of DCI risk in the early stages following ntSAH due to ruptured intracranial aneurysms. The proposed model and the derived quantitative threshold values can serve as a basis for clinical algorithms for the treatment and prevention of DCI.

 

Keywords: delayed cerebral ischemia, non-traumatic subarachnoid hemorrhage, CT perfusion, transcranial doppler.

 

Corresponding author: Sementsova O.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Sementsova O.V. An integrated model for early diagnosing delayed cerebral ischemia in patients with nontraumatic subarachnoid hemorrhage due to intracranial aneurysm rupture. REJR 2026; 16(2):6-20. DOI: 10.21569/2222-7415-2026-16-2-6-20.

Received:        05.05.26 Accepted:       01.08.26