Abstract T P354: The Role of Lindegaard Ratio on TCD for Predicting Angiographic Vasospasm Following Aneurysmal Subarachnoid Haemorrhage

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Aftab Ahmad ◽  
Khurshid Khan ◽  
Ghazala Basir ◽  
Carol Derksen ◽  
Ashfaq Shuaib ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Mean Flow ◽  
Anterior Circulation ◽  
University Of Alberta ◽  
Angiographic Vasospasm ◽  
Luminal Narrowing ◽  
Study Population ◽  
Higher Sensitivity

Background and objective: Middle cerebral artery (MCA) Lindegaard ratio (LR) has been used as indicator of moderate to severe vasospasm (VSP) following subarachnoid hemorrhage (SAH). However there have been many criticisms about the ability to detect impending vasospasm using Transcranial Doppler (TCD). The purpose of this study was to determine the correlation between TCD Mean Flow Velocities (MFV) and angiographic VSP after aneurysmal SAH using LR of several anterior circulation vessels. Methods: The study population included prospective collected data of 134 patients with aneurysmal SAH admitted to University of Alberta hospital from January 2006 to December 2008. Complete TCD was performed daily from day 2 to 14 from symptoms onset. All patients underwent cerebral angiography on admission and within 7 days following onset of symptoms. The M1, M2 MCA, ACA and intracranial ICA/ipsilateral extra cranial ICA velocity ratios (LR) were calculated and correlation was made with the presence of angiographic vasospasm (defined as more than one-third luminal narrowing). Then, anterior circulation LR was defined as the highest LR in the ipsilateral anterior circulation arteries. Moderate to severe VSP was defined as LR > 3. Results: Results are shown in table. The probability of VSP in the presence of one anterior circulation vessel LR > 3 is 14 % (2/14), 2 vessels LR >3 (4/16. 16 %), 3 vessels LR > 3 (3/6, 50 %) and 4 vessels LR >3 (5/5 = 100 %). (P< 0.001) Conclusion: LR of M2 MCA has higher sensitivity compared to other vessels and ACA LR has less sensitivity but more specificity whereas the rest of anterior circulation LR had modest predictive value. The likelihood of VSP increases as more number of vessels in anterior circulation shows LR>3. LR should not be interpreted in a blind fashion to the rest of TCD MFV numbers.

The Role of Race in Time to Treatment after Subarachnoid Hemorrhage

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 837-843 ◽  
Author(s):  
Sonia V. Eden ◽  
Lewis B. Morgenstern ◽  
Padmini Sekar ◽  
Charles J. Moomaw ◽  
Mary Haverbusch ◽  
...  
Keyword(s):  
Emergency Department ◽  
Subarachnoid Hemorrhage ◽  
Racial Differences ◽  
Univariate Analysis ◽  
Case Fatality ◽  
Anterior Circulation ◽  
Time To Treatment ◽  
Black Patients ◽  
Anterior Circulation Aneurysms

Abstract OBJECTIVE Blacks have higher mortality rates from aneurysmal subarachnoid hemorrhage (SAH) than Caucasians. The time to treatment for aneurysmal SAH has been found to correlate with mortality and outcome. Therefore, we examined racial differences in the time to treatment of aneurysmal SAH among patients from the Greater Cincinnati area. METHODS We evaluated data from 439 adult aneurysmal SAH patients prospectively identified from May 1997 to August 2001 and July 2002 to March 2005. The primary outcome measure was time to treatment, defined as elapsed time from arrival in the emergency department to aneurysm treatment. A multivariable model was constructed to determine the role of potential variables, including race, on time to treatment for SAH. RESULTS In univariate analysis, Caucasian patients were significantly older than black patients (P &lt; 0.0001) and were more likely to be male (P = 0.014), insured (P &lt; 0.0001), and transferred from emergency departments of presentation to other hospitals (P &lt; 0.0001). Black patients were more likely to have anterior circulation aneurysms (P = 0.009) and preexisting hypertension (P &lt; 0.001). In univariate analysis, anterior circulation aneurysms showed a trend toward earlier treatment than posterior circulation aneurysms (P = 0.07). In multivariable models, race was not associated with time to treatment or case-fatality rate. Patients transferred from other facilities were treated more expeditiously than patients who presented directly to the emergency department (P = 0.003), and a history of diabetes mellitus was associated with delay in treatment (P = 0.05). CONCLUSION Race was not associated with time to treatment after aneurysmal SAH in the Greater Cincinnati area. Reducing the increased burden of SAH mortality among blacks must be addressed at the prevention stage.

scholarly journals Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Jennifer Göttsche ◽  
Nils Schweingruber ◽  
Julian Christopher Groth ◽  
Christian Gerloff ◽  
Manfred Westphal ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Oral Administration ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Local Treatment ◽  
Transcranial Doppler Sonography ◽  
Clinical Effects ◽  
Mean Flow ◽  
Anterior Circulation ◽  
Treatment Regimens

Objective: Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v.), depending on clinical conditions and local treatment regimens. We have therefore investigated the safety and clinical effects of switching from i.v. to oral nimodipine therapy.Methods: Patients with aneurysmal SAH between January 2014 and April 2018 and initial i.v. nimodipine therapy, which was subsequently switched to oral administration, were included in this retrospective study. Transcranial Doppler sonography (TCD) of the vessels of the anterior circulation was performed daily. The occurrence of vasospasm and infarction during the overall course of the treatment was recorded. Statistical level of significance was set to p &lt; 0.05.Results: A total of 133 patients (mean age 55.8 years, 65% female) initially received nimodipine i.v. after aneurysmal SAH, which was subsequently switched to oral administration after a mean of 12 days. There were no significant increases in mean flow velocities on TCD after the switch from i.v. to oral nimodipine administration regarding the anterior cerebral artery. For the middle cerebral artery, an increase from 62.36 to 71.78 cm/sec could only be detected in the subgroup of patients with infarction. There was no clustering of complicating events such as new-onset vasospasm or infarction during or after the switch.Conclusions: Our results do not point to any safety concerns when switching nimodipine from initial i.v. to oral administration. Switching was neither associated with clinically relevant increases in TCD velocities nor other relevant adverse events.

Distribution of Angiographic Vasospasm after Subarachnoid Hemorrhage: Implications for Diagnosis by Transcranial Doppler Ultrasonography

Neurosurgery ◽  
1990 ◽  
Vol 27 (4) ◽  
pp. 574-577 ◽  
Author(s):  
David W. Newell ◽  
Sean M. Grady ◽  
Joseph M. Eskridge ◽  
Richard H. Winn
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Transcranial Doppler Ultrasound ◽  
Anterior Circulation ◽  
Detection Range ◽  
Angiographic Vasospasm ◽  
Number Of Patients ◽  
Typical Distribution ◽  
Anterior Circulation Aneurysms

Abstract A study was undertaken to determine how frequently angiographic vasospasm occurs outside the normal access range of transcranial Doppler ultrasound in patients who have suffered a subarachnoid hemorrhage. Vasospasm located in the basal vessels is readily identifiable using transcranial Doppler ultrasound whereas spasm affecting the more distal, vertically oriented arteries is outside the standard detection range. It is therefore speculated that the sensitivity of the technique would be adversely affected by a high incidence of distal vasospasm. A total of 136 angiograms performed on 68 patients after a subarachnoid hemorrhage from anterior circulation aneurysms were reviewed to determine the typical distribution of vasospasm. Of the 40 cases that showed &gt;25% vessel narrowing, 50.0% had spasm restricted to the basal vessels, 42.5% had spasm involving both basal and distal segments, and 7.5% had spasm of the distal segments only. None of the patients with distal vasospasm alone developed delayed ischemic deficits. It is concluded that most patients with anterior circulation aneurysms who develop vasospasm will have involvement of the basal vessels, but a small number of patients may develop vasospasm only in distal vessels.

scholarly journals The Role of Arterioles and the Microcirculation in the Development of Vasospasm after Aneurysmal SAH

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Masato Naraoka ◽  
Naoya Matsuda ◽  
Norihito Shimamura ◽  
Kenichiro Asano ◽  
Hiroki Ohkuma
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Relative Risk ◽  
Cerebral Ischemia ◽  
Clinical Outcome ◽  
Cerebral Arteries ◽  
Delayed Cerebral Ischemia ◽  
Microcirculatory Disturbance ◽  
Angiographic Vasospasm ◽  
Successful Reduction

Cerebral vasospasm of the major cerebral arteries, which is characterized by angiographic narrowing of those vessels, had been recognized as a main contributor to delayed cerebral ischemia (DCI) in subarachnoid hemorrhage (SAH) patients. However, the CONSCIOUS-1 trial revealed that clazosentan could not improve mortality or clinical outcome in spite of successful reduction of relative risk in angiographic vasospasm. This result indicates that the pathophysiology underlying DCI is multifactorial and that other pathophysiological factors, which are independent of angiographic vasospasm, can contribute to the outcome. Recent studies have focused on microcirculatory disturbance, such as microthrombosis and arteriolar constriction, as a factor affecting cerebral ischemia after SAH. Reports detecting microthrombosis and arteriolar constriction will be reviewed, and the role of the microcirculation on cerebral ischemia during vasospasm after SAH will be discussed.

ADMISSION ANGIOGRAPHIC CEREBRAL CIRCULATION TIME MAY PREDICT SUBSEQUENT ANGIOGRAPHIC VASOSPASM AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2007 ◽  
Vol 61 (6) ◽  
pp. 1152-1161 ◽  
Author(s):  
Joshua D. Udoetuk ◽  
Michael F. Stiefel ◽  
Robert W. Hurst ◽  
John B. Weigele ◽  
Peter D. LeRoux
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Circulation ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Circulation Time ◽  
Anterior Circulation ◽  
Angiographic Vasospasm ◽  
Group A ◽  
Vessel Resistance ◽  
Group B ◽  
Cerebral Circulation Time

Abstract OBJECTIVE Angiographic cerebral vasospasm occurs in approximately 70% of patients hospitalized after aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor outcome. In this study, we examined whether or not cerebral circulation time (CCT) measured with digital subtraction angiography was associated with angiographic vasospasm. METHODS Patients who underwent cerebral angiography within 24 hours of SAH were analyzed. Contrast dye transit time from the arterial to the venous phase was measured to obtain CCT (supraclinoid internal carotid artery to parietal cortical veins) and microvascular CCT (cortical middle cerebral artery to parietal cortical veins). Patients with ruptured anterior circulation aneurysms and vasospasm on follow-up angiography (Group A) were compared with patients with SAH without vasospasm (Group B) and with normal control subjects (Group C). RESULTS There were 20 patients in Group A (mean age, 51 ± 13 yr), 17 patients in Group B (56 ± 12 yr), and 98 patients in Group C (52 ± 12 yr). CCT in patients in Group A (7.7 ± 1.9 s) was significantly longer than those in Groups B (6.6 ± 1.2 s; P = 0.005) and C (5.9 ± 1 s; P &lt; 0.001). Microvascular CCT in patients in Group A (7.1 ± 1.8 s) was significantly longer than those in Groups B (6.1 ± 1.2 s; P = 0.003) and C (5.4 ± 0.9 s; P &lt; 0.001). CONCLUSION Prolonged CCT, a measurement of increased small vessel resistance, can be identified within 24 hours after SAH and is associated with subsequent angiographic vasospasm. These results suggest that microcirculation changes may be involved in vasospasm.

Delayed infarction following aneurysmal subarachnoid hemorrhage: Can the role of severe angiographic vasospasm really be dismissed?

2015 ◽  
Vol 8 (8) ◽  
pp. 802-807 ◽  
Author(s):  
Alex M Mortimer ◽  
Brendan Steinfort ◽  
Ken Faulder ◽  
Timothy Harrington
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Minor Role ◽  
Cross Sectional ◽  
Angiographic Vasospasm ◽  
Pathophysiological Role ◽  
Cross Sectional Imaging ◽  
A Minor

BackgroundThe recent literature pertaining to delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage has downplayed the role of angiographic vasospasm. However, it is our hypothesis that angiographic vasospasm has a significant pathophysiological role in this disease. We undertook an observational radiographic study of patients who presented in a delayed manner (>72 h from ictus) with evidence of severe angiographic vasospasm on initial angiography in order to describe an apparent association between vasospasm and infarct location.MethodsThis was a retrospective study of consecutive patients treated at our unit. Initial, subsequent, and follow-up cross-sectional imaging with CT or MRI was analyzed in conjunction with initial angiography. Sites of angiographic narrowing, angiographic hypoperfusion, and subsequent sites of infarction were assessed.ResultsThirteen patients (6 women, 7 men) of mean age 49 years were assessed. Mean time to presentation was 6 days. All had severe angiographic vasospasm. Nine of the 13 patients suffered infarction; the infarcts in seven of the nine patients were large. There was correlation between sites of angiographic narrowing and infarction in all cases and eight of the nine cases showed angiographic hypoperfusion in a location corresponding to eventual infarct location.ConclusionsSevere angiographic vasospasm may be linked to infarction in patients who present late. These infarcts are mostly large despite maximal treatment. We question the notion that proximal vasospasm has a minor role in delayed ischemia.

scholarly journals The role of Transcranial Doppler in the detection of vasospasm after subarachnoid hemorrhage: updates and new parameters

2021 ◽  
Author(s):  
Isaac Rêgo Purificação ◽  
João Gustavo dos Anjos Morais Oliveira ◽  
Gabriela Sarno Brandão ◽  
Ana Flávia Paiva Bandeira Assis ◽  
Leonardo Mattos Santos ◽  
...  
Keyword(s):  
Public Health ◽  
Subarachnoid Hemorrhage ◽  
Transcranial Doppler ◽  
Delayed Cerebral Ischemia ◽  
High Sensitivity ◽  
High Specificity ◽  
High Accuracy ◽  
School Of Medicine ◽  
Angiographic Vasospasm

Introduction: Transcranial Doppler (DTC) is useful in the evaluation of vasospasm after subarachnoid hemorrhage (SAH). Thus, it is important to know the accuracy and impact of this tool in the management of patients. Objective: Analyze the use of DTC in the detection of vasospasm after subarachnoid hemorrhage and its clinical relevance. Design and Setting: This is a literature review, produced in Bahiana School of Medicine and Public Health, Bahia, Brazil. Methods: The evaluated studies were obtained in PubMed, published since 2010. The studies did not correspond with the purpose of this review were excluded. Results: 26 of the 515 articles found, were select. Clinical studies that sought to demonstrate the accuracy of TCD in the detection of vasospasm and prediction of Delayed Cerebral Ischemia show high sensitivity and negative predictive value.There are studies that measure the accuracy of DTC in detecting angiographic vasospasm with high specificity. New parameters are emerging for the detection of vasospasm, even early. However, there are studies that demonstrate that the use of TCD does not favor the clinical outcomes of patients after SAH. Conclusion: TCD has moderate-high accuracy and can help in the detection and management of patients with vasospasm. Nonetheless, there are studies that refute the relevance of TCD in HSA. Furthermore, there is a lack of concrete evidence, with larger studies, for the widespread use of this tool with greater reliability and precision.

Evidence for a conditioning effect of inhalational anesthetics on angiographic vasospasm after aneurysmal subarachnoid hemorrhage

2020 ◽  
Vol 133 (1) ◽  
pp. 152-158 ◽  
Author(s):  
Umeshkumar Athiraman ◽  
Diane Aum ◽  
Ananth K. Vellimana ◽  
Joshua W. Osbun ◽  
Rajat Dhar ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariate Logistic Regression Analysis ◽  
Secondary Brain Injury ◽  
Large Artery ◽  
Inhalational Anesthetics ◽  
Angiographic Vasospasm ◽  
Inhalational Anesthetic

OBJECTIVEDelayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is characterized by large-artery vasospasm, distal autoregulatory dysfunction, cortical spreading depression, and microvessel thrombi. Large-artery vasospasm has been identified as an independent predictor of poor outcome in numerous studies. Recently, several animal studies have identified a strong protective role for inhalational anesthetics against secondary brain injury after SAH including DCI—a phenomenon referred to as anesthetic conditioning. The aim of the present study was to assess the potential role of inhalational anesthetics against cerebral vasospasm and DCI in patients suffering from an SAH.METHODSAfter IRB approval, data were collected retrospectively for all SAH patients admitted to the authors’ hospital between January 1, 2010, and December 31, 2013, who received general anesthesia with either inhalational anesthetics only (sevoflurane or desflurane) or combined inhalational (sevoflurane or desflurane) and intravenous (propofol) anesthetics during aneurysm treatment. The primary outcomes were development of angiographic vasospasm and development of DCI during hospitalization. Univariate and logistic regression analyses were performed to identify independent predictors of these endpoints.RESULTSThe cohort included 157 SAH patients whose mean age was 56 ± 14 (± SD). An inhalational anesthetic–only technique was employed in 119 patients (76%), while a combination of inhalational and intravenous anesthetics was employed in 34 patients (22%). As expected, patients in the inhalational anesthetic–only group were exposed to significantly more inhalational agent than patients in the combination anesthetic group (p < 0.05). Multivariate logistic regression analysis identified inhalational anesthetic–only technique (OR 0.35, 95% CI 0.14–0.89), Hunt and Hess grade (OR 1.51, 95% CI 1.03–2.22), and diabetes (OR 0.19, 95% CI 0.06–0.55) as significant predictors of angiographic vasospasm. In contradistinction, the inhalational anesthetic–only technique had no significant impact on the incidence of DCI or functional outcome at discharge, though greater exposure to desflurane (as measured by end-tidal concentration) was associated with a lower incidence of DCI.CONCLUSIONSThese data represent the first evidence in humans that inhalational anesthetics may exert a conditioning protective effect against angiographic vasospasm in SAH patients. Future studies will be needed to determine whether optimized inhalational anesthetic paradigms produce definitive protection against angiographic vasospasm; whether they protect against other events leading to secondary brain injury after SAH, including microvascular thrombi, autoregulatory dysfunction, blood-brain barrier breakdown, neuroinflammation, and neuronal cell death; and, if so, whether this protection ultimately improves patient outcome.

Sign in / Sign up

Export Citation Format

Share Document