scholarly journals Association of Transcranial Doppler Blood Flow Velocity Slow Waves with Delayed Cerebral Ischemia in Patients Suffering from Subarachnoid Hemorrhage: A Retrospective Study

2021 ◽  
Author(s):  
Vasilios Papaioannou ◽  
Karol Budohoski ◽  
Michal Placek ◽  
Zofia Czosnyka ◽  
Peter Smielewski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Delayed Cerebral Ischemia ◽  
Area Under The Curve ◽  
Slow Waves

Abstract BackgroundCerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial doppler (TCD)-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia.MethodsA retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in 2 groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Complexity of CBFV was estimated through measurement of sample entropy (SampEn). ResultsIn the whole population (N=32), magnitude of SWs of ipsilateral to VS side CBFV was higher during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/sec, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group ( N =19, p < 0.001) and were strongly predictive of DCI, with area under the curve (AUC) = 0.745 (p = 0.02). Vasospasm caused a non-significant shortening of ipsilateral values of tau and increase in SampEn in all patients related to pre VS measurements, as well as an insignificant increase of Mxa in DCI related to non-DCI group (N = 13).ConclusionsIn patients suffering from subarachnoid hemorrhage, TCD-detected VS was associated with higher ipsilateral CBFV SWs, related to pre-VS measurements. Higher CBFV SWs before VS were significantly predictive of delayed cerebral ischemia.

scholarly journals Association of transcranial Doppler blood flow velocity slow waves with delayed cerebral ischemia in patients suffering from subarachnoid hemorrhage: a retrospective study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Vasilios E. Papaioannou ◽  
Karol P. Budohoski ◽  
Michal M. Placek ◽  
Zofia Czosnyka ◽  
Peter Smielewski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Delayed Cerebral Ischemia ◽  
Area Under The Curve ◽  
Slow Waves

Abstract Background Cerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial Doppler (TCD)-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia. Methods A retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in two groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Complexity of CBFV was estimated through measurement of sample entropy (SampEn). Results In the whole population (N = 32), magnitude of SWs of ipsilateral to VS side CBFV was higher during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/s, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group (N = 19, p < 0.001) and were strongly predictive of DCI, with area under the curve (AUC) = 0.745 (p = 0.02). Vasospasm caused a non-significant shortening of ipsilateral values of tau and increase in SampEn in all patients related to pre-VS measurements, as well as an insignificant increase of Mxa in DCI related to non-DCI group (N = 13). Conclusions In patients suffering from subarachnoid hemorrhage, TCD-detected VS was associated with higher ipsilateral CBFV SWs, related to pre-VS measurements. Higher CBFV SWs before VS were significantly predictive of delayed cerebral ischemia.

scholarly journals Association of Different Transcranial Doppler-derived Indices of Cerebrovascular Dynamics With Delayed Cerebral Ischemia in Patients Suffering From Subarachnoid Hemorrhage: A Retrospective Study

2020 ◽  
Author(s):  
Vasilios Papaioannou ◽  
Karol Budohoski ◽  
Michal Placek ◽  
Zofia Czosnyka ◽  
Peter Smielewski ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Transcranial Doppler ◽  
Cerebral Blood Flow Velocity ◽  
Delayed Cerebral Ischemia ◽  
Area Under The Curve ◽  
Arterial Blood ◽  
Potential Association ◽  
Temporal And Spatial ◽  
The Relationship

Abstract Background Cerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial doppler-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia.MethodsA retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in 2 groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) and arterial blood pressure was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Results In the whole population (N=32), magnitude of SWs of ipsilateral CBFV was increased during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/sec, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group (p < 0.001) and were strongly predictive of DCI, with area under the curve = 0.745, p = 0.009. VS caused shortening of tau (ipsilateral to spasm: 0.17 ± 0.08 vs before: 0.25 ± 0.17 sec, p = 0.04) and interhemispheric asymmetry with lower values on ipsilateral side (p < 0.01). In patients with DCI (N=19), Mxa was increased during VS (ipsilateral to spasm: 0.36 ± 0.18 vs before: 0.26 ± 0.23, p = 0.04). ConclusionsIn the whole group of patients, VS was associated with increased CBFV SWs in both temporal and spatial assessments. Greater SWs before VS in DCI group, were strongly predictive of DCI.

The Utility of Using the Bispectral Index–Vista for Detecting Cross-Clamping Decline in Cerebral Blood Flow Velocity

2010 ◽  
Vol 67 (3) ◽  
pp. ons102-ons107 ◽  
Author(s):  
Ashraf A. Dahaba ◽  
Ji Xiu Xue ◽  
Yang Hua ◽  
Qing Hai Liu ◽  
Guo Xun Xu ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Ischemia ◽  
Carotid Endarterectomy ◽  
Flow Velocity ◽  
Bispectral Index ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Coefficient Of Determination ◽  
Discriminative Power

Abstract BACKGROUND: Patients undergoing carotid endarterectomy for extracranial internal carotid artery stenosis are at risk of cerebral ischemia/hypoperfusion. Criterion recommended by European and American committees to determine whether to place a shunt consisted of a decline in transcranial Doppler ultrasonography-measured middle cerebral artery blood flow velocity (MCBFV) to &lt; 30% to 40% of intraoperative preclamp value. OBJECTIVE: To assess the discriminative power of the bispectral index (BIS)—Vista monitor for detecting a 40% decline in MCBFV with cross-clamping. METHODS: In 20 patients undergoing carotid endarterectomy under remifentanil/propofol anesthesia, BIS—Vista data, MCBFV, and pulsatility index from bilaterally mounted BIS—Vista and transcranial Doppler monitors were continuously recorded. RESULTS: Coefficient of determination revealed good correlation (r2 = 0.763) between ipsilateral BIS—Vista and MCBFV after cross-clamping. BIS—Vista exhibited a high discriminative power of 0.850 (95% confidence interval, 0.455–0.966) area under the receiver-operating characteristic curve in detecting an ipsilateral 40% MCBFV decline. Two-way analysis of variance (location by time) suggests that BIS—Vista exhibited a global decline; ie, both BIS—Vistas declined when 1 carotid on either side was clamped because there was no significant interhemispheric difference (P = .112) in mean BIS—Vista values over time. CONCLUSION: Although we demonstrated good correlation and high discriminative power of the BIS—Vista monitor in depicting a MCBFV decline that could serve as indicator of decline in cerebral activity, BIS—Vista cannot be considered a reliable indicator of cerebral ischemia/hypoperfusion that could replace transcranial Doppler monitoring to determine whether a shunt is to be placed.

Biphasic Cerebral Blood Flow Velocity Profile in Patients With Aneurysmal Subarachnoid Hemorrhage

2004 ◽  
Vol 1 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Andreas R. Luft ◽  
Manuel M. Buitrago ◽  
Michel Torbey ◽  
Anish Bhardwaj ◽  
Alexander Razumovsky
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Velocity Profile ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Flow Velocity Profile

scholarly journals Dexmedetomidine Decreases Cerebral Blood Flow Velocity in Humans

1993 ◽  
Vol 13 (2) ◽  
pp. 350-353 ◽  
Author(s):  
Mark H. Zornow ◽  
Mervyn Maze ◽  
J. Barry Dyck ◽  
Steven L. Shafer
Keyword(s):  
Blood Flow ◽  
Arterial Pressure ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Infusion Pump ◽  
Plasma Concentrations ◽  
Transcranial Doppler Sonography ◽  
Drug Infusion

This study was designed to determine the effects of dexmedetomidine on CBF velocity as measured by transcranial Doppler sonography in human volunteers. Dexmedetomidine, a potent α-2 adrenergic agonist, was administered by computer-driven infusion pump to six male volunteers. Serial measurements of middle cerebral artery blood flow velocity at four steady-state plasma concentrations of dexmedetomidine were made with a 2-MHz transcranial Doppler transducer via the temporal window. The targeted plasma concentrations were 0.49, 0.65, 0.81, and 0.97 ng/ml. These represent 60, 80, 100, and 120%, respectively, of the mean peak concentration following the intramuscular administration of 2 μg/kg of dexmedetomidine. Subjects experienced a significant degree of sedation at the highest infusion rates. Mean CBF velocity decreased with each increase in plasma concentration of dexmedetomidine and then began to return to basal levels after termination of the infusion. A trend toward an increase in the pulsatility index at the higher levels of dexmedetomidine suggests that the observed decrement in CBF velocity was due to an increase in cerebral vascular resistance. Upon initiation of the drug infusion, mean arterial pressure decreased from ∼95 mm Hg to 78 mm Hg. There were no further decreases in arterial pressure with subsequent increases in plasma concentrations of dexmedetomidine. Arterial carbon dioxide tension increased to a maximum of 45 mm Hg during the drug infusion, but this increase from baseline was not statistically significant. These studies are in agreement with previous animal studies which demonstrate a decrease in CBF after administration of dexmedetomidine.

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