Abstract WP294: CT Angiography Spot Sign Predicts Perioperative Bleeding in Primary Intracerebral Hemorrhage
Purpose: While hematoma evacuation for intracerebral hemorrhage (ICH) showed no clinical benefit in one large randomized trial, meta-analyses have suggested an effect for certain subgroups. Knowledge of which patients will be found to show active bleeding may help guide surgical treatment. The spot sign, i.e. contrast extravasation following CT angiography (CTA), is thought to represent active bleeding. We therefore investigated whether spot sign presence predicts active bleeding during surgery for ICH.
Methods: Consecutive primary ICH patients who underwent a CTA followed by surgical hematoma evacuation were included over a 10-year period. CTAs were reviewed for spot sign presence by an experienced reader, blinded to clinical and surgical data. Active bleeding and re-bleeding following surgery were assessed using 5-point rating scales. The association between the spot sign and active perioperative bleeding, postoperative re-bleeding, and postoperative change in hematoma volume was evaluated using univariate and multivariate logistic regression.
Results: During the study period, 1082 ICH patients presented to our institution, of whom 75 met inclusion criteria. 34 (45%) were lobar, 13 (17%) deep, 26 (35%) cerebellar, 1 (1%) brainstem, and 1 (1%) primary intraventricular hemorrhage. At least one spot sign was identified in 29 patients (39%). In multivariate analysis, spot sign was the sole predictor of active bleeding during surgery (OR 2.86 [95%CI 1.05-8.17], p = 0.044). Presence of spot sign (OR 4.46 [95%CI 1.24-18.17], p = 0.027) and female sex (OR 6.71 [95%CI 1.79-33.28], p = 0.009) were predictive of re-bleeding and larger postoperative ICH volumes. A trend toward significance was found for the association of re-bleeding with both discharge mortality (p = 0.055) and 90-day mortality (p = 0.073).
Conclusion: This is the first study to show that CTA spot sign marks ongoing bleeding in patients undergoing hematoma evacuation following acute ICH. Patients with this finding suffer more perioperative bleeding, more postoperative re-bleeding, and larger residual ICH volumes. Our results may contribute to the selection of which ICH patients may benefit from surgery.
- © 2012 by American Heart Association, Inc.