Decreased Flow Velocity with Transcranial Color-Coded Duplex Sonography Correlates with Delayed Cerebral Ischemia due to Peripheral Vasospasm of the Middle Cerebral Artery

Autor: Michiyasu Suzuki, Hirokazu Sadahiro, Yuichi Fujiyama, Satoshi Shirao, Takayuki Oku, Akiko Yamane, Kazutaka Sugimoto, Hiroshi Yoneda, Akinori Inamura, Hideyuki Ishihara
Rok vydání: 2016
Předmět:
Male
Middle Cerebral Artery
Time Factors
Subarachnoid hemorrhage
Vasodilator Agents
Ischemia
Vasodilation
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
medicine.artery
medicine
Humans
Vasospasm
Intracranial
cardiovascular diseases
Ultrasonography
Doppler
Color
Aged
Retrospective Studies
business.industry
Rehabilitation
Angiography
Digital Subtraction
Infarction
Middle Cerebral Artery
Vasospasm
Middle Aged
Subarachnoid Hemorrhage
medicine.disease
Cerebral Angiography
Peripheral
Transcranial Doppler
Treatment Outcome
Flow velocity
Vasoconstriction
Cerebrovascular Circulation
Anesthesia
Middle cerebral artery
cardiovascular system
Female
Surgery
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Blood Flow Velocity
030217 neurology & neurosurgery
circulatory and respiratory physiology
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 25:2352-2359
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.032
Popis: Background and Objective Despite intensive therapy, vasospasm remains a major cause of delayed cerebral ischemia (DCI) in worsening patient outcome after aneurysmal subarachnoid hemorrhage (aSAH). Transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS) are noninvasive modalities that can be used to assess vasospasm. However, high flow velocity does not always reflect DCI. The purpose of this study was to investigate the utility of TCD/TCCS in decreasing permanent neurological deficits. Methods We retrospectively enrolled patients with aSAH who were treated within 72 hours after onset. TCCS was performed every day from days 4 to 14. Peak systolic velocity (PSV), mean velocity (MV), and pulsatility index were recorded and compared between DCI and non-DCI patients. In patients with DCI, endovascular therapy was administered to improve vasospasm, which led to a documented change in velocity. Results Of the 73 patients, 7 (9.6%) exhibited DCI. In 5 of the 7 patients, DCI was caused by vasospasm of M2 or the more peripheral middle cerebral artery (MCA), and the PSV and MV of the DCI group were lower than those of the non-DCI group after day 7. Intra-arterial vasodilator therapy (IAVT) was performed for all patients with DCI immediately to increase the flow volume by the next day. Conclusions Increasing flow velocity cannot always reveal vasospasm excluding M1. In patients with vasospasm of M2 or more distal arteries, decreasing flow velocity might be suggestive of DCI. IAVT led to increases in the flow velocity through expansion of the peripheral MCA.
Databáze: OpenAIRE
Externí odkaz: