Résumé
Background: delayed cerebral infarction (DCI) after aneurysmal subarachnoid haemorrhage (aSAH) is a singular pathological entity. Because of its impact on mortality and morbidity, it requires early diagnostic methods and both prophylactic and curative treatments. However, management strategies are only few and lack consensus. This study explores the effects of a management strategy based on perfusion computed tomography (CTP) and systemic administration of milrinone on DCI. Methods: we performed a retrospective before-after monocentric study including adult patients hospitalized for aSAH during two distinct periods, from 2014 to 2016 and from 2018 to 2021. The "after" period was singularized by a management strategy based on systematic early CTP followed by clinical and transcranial Doppler (TCD) monitoring and protocoled systemic administration of milrinone. The outcome was DCI occurence. We also collected vasospasm occurrence, as well as indicators of systemic hemodynamics. Results: the "before" period included 277 patients, and the "after" one 453. Modified Fisher score III/IV were more frequent and vasospasm was more frequently diagnosed in the "after" period. In contrast, DCI occurrence was lower with the "after" management strategy (adjusted OR 0.48, 95% CI= [0.26; 0.84]). In the "after" period, clinical deficit was less frequent at the time of vasospasm diagnosis (24 versus 11%, p= 0.001), suggesting that CTP permitted early diagnosis. In patients diagnosed with vasospasm, intravenous milrinone was more frequently administered (80 versus 54%, p< 0.001) and associated with superior hemodynamics. Conclusion: the present study from a large cohort of aSAH patients strongly suggests, for one part, the interest of CTP in early diagnosis of vasospasm and DCI, and for the other the efficacy and safety of milrinone in their prevention and treatment.