Burkhardt, Jan-KarlJan-KarlBurkhardtNeidert, Marian ChristophMarian ChristophNeidertStienen, Martin NikolausMartin NikolausStienenSchöni, Daniel StephanDaniel StephanSchöniFung, ChristianChristianFungRoethlisberger, MichelMichelRoethlisbergerCorniola, Marco VincenzoMarco VincenzoCorniolaBervini, DavidDavidBerviniMaduri, RodolfoRodolfoMaduriValsecchi, DanieleDanieleValsecchiTok, SinaSinaTokSchatlo, BawarjanBawarjanSchatloBijlenga, PhilippePhilippeBijlengaSchaller, KarlKarlSchallerBozinov, OliverOliverBozinovRegli, LucaLucaRegli2024-10-252024-10-252017-07https://boris-portal.unibe.ch/handle/20.500.12422/156195INTRODUCTION To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS). RESULTS A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1-416; p < 0.0001). Patients with a spot sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04-8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU. CONCLUSION In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative aICH patients.enAneurysmal subarachnoid hemorrhage (aSAH) Computed tomography angiography (CTA) spot sign Intracerebral hemorrhage (ICH) Intraprocedural aneurysma rupture600 - Technology::610 - Medicine & healtharticle10.7892/boris.1079452812765710.1007/s00701-016-3072-1