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Original research
Quantitative analysis of hemorrhage clearance and delayed cerebral ischemia after subarachnoid hemorrhage
  1. Sang-Bae Ko1,
  2. H Alex Choi2,
  3. Raimund Helbok3,
  4. J Michael Schmidt4,
  5. Neeraj Badjatia5,
  6. Jan Claassen4,6,
  7. E Sander Connolly6,
  8. Stephan A Mayer7,
  9. Kiwon Lee2
  1. 1Department of Neurology, Seoul National University Hospital, Seoul, Korea
  2. 2Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute, Memorial Hermann of Texas Medical Center, Houston, Texas, USA
  3. 3Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
  4. 4Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
  5. 5Section of Neurocritical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
  6. 6Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
  7. 7Departments of Neurology and Neurosurgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Kiwon Lee, Division of Critical Care, Departments of Neurology and Neurosurgery, University of Texas Medical School at Houston, Houston, TX, USA; Kiwon.Lee{at}


Objective Initial hemorrhage burden is an independent predictor for delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the association between clot clearance and DCI still remains to be elucidated.

Methods Quantitative analysis of hemorrhage volume and clot clearance was made in 116 consecutive patients who were scanned within 24 h from onset. Cisternal plus intraventricular hemorrhage volume (CIHV) was calculated as clot volume from the initial scans and scans performed up to 7 days after onset. Clot clearance was calculated as a percentage of residual clot volume compared with the clot volume on the initial scan. Initial clot volume and clot clearance were dichotomized to evaluate the association with DCI.

Results Included patients were aged 55.5±15.2 years with a female preponderance (65.5%, (76/116)). The group with higher initial clot volume (≥17.2 mL) had higher odds for DCI (OR 4.3, 95% CI 1.3 to 14.0, p=0.015). However, the rate of DCI was not different between high and low clot clearance groups (26.7% vs 31.0%, p=0.66). Clot clearance rate was similar in patients with and without DCI up to day 7 after onset.

Conclusions The quantitative clot clearance rate is not an independent predictor for DCI.

  • Subarachnoid
  • Stroke
  • Aneurysm
  • Hemorrhage

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