İNTRASEREBRAL HEMATOM VE SERVİKOSEFALİK DOLİKOARTERİOPATİ

Ethem Murat ARSAVA, Mehmet Akif TOPÇUOĞLU, Rahşan GÖÇMEN, Mehmet Yasir PEKTEZEL

Özet

GİRİŞ ve AMAÇ: İntraserebral hematom ekspansiyonunun (İHE) tahmin edilmesi intraserebral hematom (İSH) yönetiminde önemlidir. Serebral mikrovasküler disfonksiyon temelinde servikosefalik dolikoarteriopati (SSD) ile İHE arasında nedensel bir ilişki bulunabilir. YÖNTEM ve GEREÇLER: İlk kraniyel BT incelemesi

Abstract

INTRODUCTION: Prediction of expansion is of critical importance in intracranial hematoma (ICH) management. Cervicocephalic dolichoarteriopathy (CCDAP) may be a readily available marker of ICH expansion (ICHE) given its possible association with cerebral microvascular dysfunction. METHODS 104 ICH patients (mean age: 64±12 years, 45% female) who had brain CT within first 12 hours, follow-up CT during first 72 hours, and CT angiography during this period were included. Basilar artery (BA) dolichoarteriopathy was graded with Smoker’s criteria; cervical carotid artery (CCA) dolichoarteriopathy with modified Wiebel-Fields & Metz scoring. ICHE criteria were absolute volume increase ≥12.5cc and ≥6cc, or percent increase ≥33% and ≥26%. RESULTS: ICHE ≥12.5 cc was detected in 10.5%; ≥6 cc in 21%, ≥33% percent increase in 20% and ≥26% in 27%. There was no significant correlation between enlarged BA diameter (>4.5 mm) and ICHE (≥12.5cc in 18%; ≥6cc in 18%, ≥33% in 19%, ≥26% in 14%). A high (≥1) Smoker’s score does not correlate significantly with ICHE (≥12.5cc in 45%; ≥6cc in 50%, ≥33% in 38%, ≥26% in 39%) ICHE was not significantly, albeit numerically lower, correlated with ≥1 score of ipsilateral modified Wiebel-Fields & Metz (≥12.5cc in 71%; ≥6cc in 80%, ≥33% in 77%, ≥26% in 82%) No dolichoarteriopathy parameters were found to be linked with functional outcome and mortality. DISCUSSION AND CONCLUSION: Although none reached statistical significance, ICHE tends to occur at a lower numerical rate as degree of CCDAP increases. The role of hypertension-induced parent artery remodeling in ICHE and its association with hypertensive microvascular adaptation may be the operating mechanism underlying this speculative protective effect.