Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;11(1):19-26.

Prediction of Symptomatic Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage Using Early Transcranial Doppler

Claudio E Scherle Matamoros  1   2 , Edgar A Samaniego  3 , Kimberly Sam  2 , Jorge A Roa  4 , Jesús Pérez Nellar  5 , Danny Rivero Rodríguez  1   2
Affiliations

Prediction of Symptomatic Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage Using Early Transcranial Doppler

Claudio E Scherle Matamoros et al. J Vasc Interv Neurol. 2020 Jan.

Abstract

Background: Symptomatic vasospasm (sVSP) is a common complication during the course of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate the efficacy and accuracy of transcranial Doppler ultrasound (TCD), performed within the first 3 days of aSAH to predict the development of sVSP.

Methods: We performed a retrospective analysis of our institutional prospectively collected database of patients with aSAH. Patients with aSAH and World Federation of Neurosurgical Societies (WFNS) grades I-III were included in the analysis. A receiver operating characteristic (ROC) curve was generated to determine cut-off values for mean flow velocities (MFVs) in the middle cerebral artery (MCA) and anterior cerebral artery (ACA) bilaterally to predict sVSP.

Results: Fifty-one patients were included in the study. Mean age was 49.8 ± 10.2 years, and 84.3% (43 patients) were women. The accuracy of measured MFVs to predict sVSP was 0.79 [95% confidence interval (CI), 0.69-0.89] and 0.77 (95% CI, 0.64-0.91) for the MCA and the ACA, respectively. In the MCA, an MFV ≥ 74 cm/s was significantly associated with a six-fold increased risk of sVSP, achieving sensitivity greater than 70%. In the ACA, an MFV ≥ 64 cm/s was significantly associated with a nine-fold increased risk of sVSP.

Conclusion: Early TCD evaluation of MFVs in the MCA and ACA is a useful tool to predict the development of sVSP in patients with acute aSAH.

Keywords: cerebral vasospasm; intracranial aneurysm; subarachnoid hemorrhage; transcranial Doppler; ultrasound.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flowchart of the cohort. ACA, anterior cerebral artery; aSAH, aneurysmal subarachnoid hemorrhage; EVD, external ventricular drain; ICP, intracranial pressure; MCA, middle cerebral artery; MFV, mean flow velocity; sVSP, symptomatic vasospasm; TCD, transcranial Doppler; WFNS, World Federation of Neurological Surgeons Scale.
Figure 2
Figure 2. Comparison of mean flow velocities (MFVs) recorded within the first 3 days of admission according to diagnosis of symptomatic vasospasm (sVSP). Measurements were obtained from the middle cerebral artery (MCA) and the anterior cerebral artery (ACA). MCA without sVSP = 61.7 ± 17.9 cm/s; MCA with sVSP = 88.1 ± 35.2 cm/s; ACA without sVSP = 47.1 ± 16.8 cm/s; ACA with sVSP = 69.5 ± 30.0 cm/s.
Figure 3
Figure 3. Receiver operating characteristic (ROC) curves for the determination of the cut-off points for the mean flow velocity in the middle cerebral artery (MCA) and the anterior cerebral artery (ACA). AUROC, area under ROC curve; CI, confidence interval.
See this image and copyright information in PMC

References

    1. Janjua N, Mayer SA. Cerebral vasospasm after subarachnoid hemorrhage. Curr Opin Crit Care. 2003;9(2):113–119. - PubMed
    1. Fisher CM, et al. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1–9. - PubMed
    1. Fotakopoulos G, et al. The value of computed tomography perfusion & transcranial Doppler in early diagnosis of cerebral vasospasm in aneurysmal & traumatic subarachnoid hemorrhage. . Future Sci OA. 2018;4(6):FSO313. - PMC - PubMed
    1. Kaufmann TJ, et al. Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology. 2007;243(3):812–819. - PubMed
    1. Choudhri O, et al. Increased risk for complications following diagnostic cerebral angiography in older patients: trends from the Nationwide Inpatient Sample (1999-2009) J Clin Neurosci. 2016;32:109–114. - PubMed

LinkOut - more resources