CT Angio improves survival in stroke patients: Lancet

A new study finds that stroke resulting from a type of brain bleeding -- known as an intracerebral haemorrhage or ICH -- could be helped by four simple checks of brain scan. The checks could help in spotting the people at the risk of further bleeding that will ensure their close monitoring. Results of the study, published in The Lancet Neurology, could help in improving outcomes for the millions of people around the world who experience a brain bleed each year.

Rustam Al-Shahi Salman, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K., and colleagues conducted the study to determine the absolute risk and predictors of intracerebral hemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography.

ICH is the most deadly form of stroke. Only one in five patients survive without permanent damage. Of the remainder, half are likely to die within a month and a half will be left with a long-term disability. Cases of ICH are diagnosed by brain scans, but until now it has been difficult to predict which patients will continue bleeding. Those who do are expected to have worse outcomes.

The research team analyzed data from studies around the world involving more than 5,000 patients and identified four factors that helped doctors predict whether patients were likely to experience further bleeding. The factors include the size of the bleed and whether or not the patient was taking medication, such as aspirin or warfarin, to thin their blood or prevent clotting.

Researchers also looked at the benefit of an advanced brain scanning technique - called CT angiography - for predicting a person's risk of ongoing bleeding. The scan involves injecting a colored dye into the patient's bloodstream and checking if it can be seen leaking into the brain.

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For patients who showed leakage of the dye, the test was of little value in addition to the four simple checks for predicting their risk of ongoing bleeding, researchers found.

Experts from dozens of research centers worldwide contributed to the study, which is the largest of its kind to date.

Key Findings:

• Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36–0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46–11·60; p<0·0001), antiplatelet use (1·68, 1·06–2·66; p=0·026), and anticoagulant use (3·48, 1·96–6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75–0·82).


• Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95–6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03–0·07).

"We have found that four simple measures help doctors to make accurate predictions about the risk of a brain hemorrhage growing. These can be used anywhere in the world. Better prediction can help us identify which patients might benefit from close monitoring and treatment. We hope that an app could help doctors to do this. The next step is to find an effective treatment to stop the bleeding." concluded Dr. Al-Shahi Salman.

For more information follow the link: https://doi.org/10.1016/S1474-4422(18)30253-9