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London, United Kingdom 2013 4 Intracerebral/subarachnoid haemorrhage and venous diseases 11:00 - 11:10 CT Angiography Spot Sign Predicts Perioperative Bleeding in Primary Intracerebral Hemorrhage H.B. Brouwers1, M.R. Raffeld2, G.J. Falcone3, A.M. Ayres4, K. Schwab5, J.M. Romero6, A. Viswanathan7, S.M. Greenberg8, C.S. Ogilvy9, J.N. Goldstein10, J. Rosand11 Massachusetts General Hospital, Harvard Medical School, Boston, USA1,Massachusetts General Hospital, Harvard Medical School, Boston, USA2, Massachusetts General Hospital, Harvard Medical School, Boston, USA3, Massachusetts General Hospital, Harvard Medical School, Boston, USA4, Massachusetts General Hospital, Harvard Medical School, Boston, USA5, Massachusetts General Hospital, Harvard Medical School, Boston, USA6, Massachusetts General Hospital, Harvard Medical School, Boston, USA7, Massachusetts General Hospital, Harvard Medical School, Boston, USA8, Massachusetts General Hospital, Harvard Medical School, Boston, USA9, Massachusetts General Hospital, Harvard Medical School, Boston, USA10, Massachusetts Gen-eral Hospital, Harvard Medical School, Boston, USA11 BACKGROUND: While hematoma evacuation for intracerebral hemorrhage (ICH) showed no clinical benefit in one large randomized trial, meta-analyses have suggested an effect in certain subgroups. Identification of patients who are actively bleeding would help guide surgical treat-ment. Contrast extravasation following CT angiography (CTA), the ‘spot sign’, 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. CTAs were reviewed for spot sign presence by an ex-perienced reader, blinded to clinical and surgical data. Active bleeding and re-bleeding were assessed using 5-point rating scales. The association between the spot sign and active perioper-ative bleeding, postoperative re-bleeding, and postoperative change in hematoma volume was evaluated using uni- and multivariate logistic regression. RESULTS: 75 patients met inclusion criteria: 34 lobar, 14 deep, 26 cerebellar, and 1 brainstem ICH. 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 (compiled outcome). 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 the 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 help select which ICH patients may benefit from surgery. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 129 3 Intracerebral/subarachnoid haemorrhage and venous diseases 10:50 - 11:00 Attack rates and survival for AVM related intracranial haemorrhage in a large Australian population 2001-09. The OASIS Study. J.M. Worthington1, M. Gattellari2, C. Goumas3, M Jaeger4, B Jalaludin5 Ingham Institute of Applied Medical Research and South Western Sydney Clinical School, University of New South Wales, Liverpool, AUSTRALIA1,Ingham Institute of Ap-plied Medical Research and University of New South Wales, Liverpool, AUSTRALIA2, In-gham Institute of Applied Medical Research and University of New South Wales, Liverpool, AUSTRALIA3, Ingham Institute of Applied Medical Research and South Western Sydney Clin-ical School, University of New South Wales, Liverpool, AUSTRALIA4, Ingham Institute of Applied Medical Research and University of New South Wales, Liverpool, AUSTRALIA5 Background: Outcomes and epidemiology of arterio-venous malformation (AVM) related hae-morrhages are under-researched. Methods: All cases of non-traumatic intracranial bleeding and AVM presenting to hospitals in New South Wales, Australia (population 7 million), between 2001 and 2009, were followed to June 2010. Crude and standardised attack rates (WHO world population) were calculated. Age and sex-adjusted mortality rates were calculated using Cox-regression analyses. Results: 844 eligible admissions in 817 patients were identified and 86% of cases had SAH alone. Seizures were identified acutely in 9.4% of all bleeds. The average age of patients with non-SAH bleeding was 48.2 years and those with SAH were significantly older at 57.1 years (p<0.05). Hypertension was significantly more prevalent in patients with SAH than in non- SAH bleeding, at 48.1% Vs 33.3% respectively (p<0.05). Crude attack rates, per 1,000,000 persons were 18.7 for males and 18.8 for females. The age-standardised rate was 17.3 (95% CI=15.6-19.0) and 16.3 (95% CI=14.7-17.9) per 1,000,000 males and females, respectively. The age-standardised rates were 14.2 per 1,000,000 for males and females with SAH and 2.3 and 1.6 per 1,000,000 males and females for non- SAH bleeding, respectively. Attack rates increased with age. The sex and age-adjusted 30-day mortality rate after AVM related SAH was 20.2% (95% CI=16.5-23.7) and 21.7% without SAH. Mortality increased marginally by 365-days to 23.8% and 25.9%, respectively. By nine-years, 30.8% (95% CI=25.7-35.4) of patients with SAH had died compared with 35.1% (95% CI=21.0-46.6) without SAH bleeding (p=0.49). Conclusion: Intracranial haemorrhage attributable to AVMs appears uncommon. A large major-ity have SAH and those patients are significantly older and have a higher prevalence of hyper-tension. Attack rates for those with and without SAH increased with age and the 30-day mortal-ity was around 20% with and without SAH, rising modestly by one year.


Karger_ESC London_2013
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