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Relative changes in flow velocities in vasospasm after subarachnoid hemorrhage

A transcranial doppler study

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Abstract

Introduction: Transcranial Dopplers (TCDs) have been used to monitor cerebral blood flow velocities in subarachnoid hemorrhage (SAH). The purpose of our two-part study was to compare the reliability of relative increases in flow velocities with conventionally used absolute flow velocity indices and to correct for hyperemia-induced flow velocity change.

Methods:Part 1: Charts of 50 patients admitted to Hahnemann University Hospital with aneurismal SAH were reviewed. Mean middle cerebral artery maximum flow velocities (MCA-MFV) were reviewed for initial flow velocities (IFVs) and maximal flow velocities (MFVs) that were reached during hospital course. Correlating flow velocities (SFVs) were noted in patients who developed symptomatic vasospasm. MFV/IFV and SFV/IFV ratios were calculated to evaluate relative changes in flow velocity. Part 2: Correction for hyperemia was derived from Lindegaards Ratio using extracranial internal carotid artery (ICA) flow velocity ratio (corrected MCA-MFV/observed MCA-MFV=EC-ICAFV (day1)/observed EC-ICAFV).

Results:Part 1: All 10 patients who developed symptomatic vasospasm exhibited a twofold increase (SFV/IFV: >2) in flow velocities prior to developing symptomatic vasospasm, and 5 patients had a threefold increase (SFV/IFV: >3). Of the 40 patients who did not develop symptomatic vasospasm, 33 patients did not have a twofold increase in their flow velocities at any time. The positive predictive value for MFV/IFV greater than 3 (n=6) and SFV/IFV greater than 3 (n=5) was 100%. The negative predictive value for MFV/IFV less than 2 (n=33) was 100%. Data using relative changes (twofold increase) in flow velocity was more sensitive (100 to 90%), specific (83 to 70%), and predictive (positive predictive value [PPV]: 59 to 45%; negative predictive value [NPV]: 100 to 97%) for symptomatic vasospasm than absolute flow velocity indices using MCA-MFV greater than 120—even in combination with Lindegaards Ratio (MCA/ICA greater than 3).

Part 2: Correction for hyperemia by modifying Lindegaard’s Index in the 32 patients where data was available improved the PPV of absolute flow velocities from 44 to 62%. In this population, the application of this equation while evaluating relative change in flow velocities improved PPV of twofold increase from 57 to 73%.

Conclusion: Relative changes in flow velocities in patients with aneurysmal SAH correlated better with clinically significant vasospasm than absolute flow velocity indices. Correction for hyperemia improved predictive value of TCD in vasospasm.

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References

  1. Charpentier C, Audibert G, Guillemin F, et al. Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 1999;30:1402–1408.

    PubMed  CAS  Google Scholar 

  2. Allen GS, Ahn HS, Preziosi TJ, et al. Cerebral arterial spasm: a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 1983;308:619–624.

    Article  PubMed  CAS  Google Scholar 

  3. Meyer FB. Calcium antagonists and vasospasm. Neurosurg Clin N Am 1990;1:367–376.

    PubMed  CAS  Google Scholar 

  4. Tettenborn D, Dycka J. Prevention and treatment of delayed ischemic dysfunction in patients with aneurysmal subarachnoid hemorrhage. Stroke 1990;21(Suppl 12):IV85-IV89.

    PubMed  CAS  Google Scholar 

  5. Lennihan L, Mayer SA, Fink ME, et al. Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial. [Clinical Trial. Journal Article. Randomized Controlled Trial] Stroke 2000;31(2):383–391.

    PubMed  CAS  Google Scholar 

  6. Origitano TC, Wascher TM, Reichman OH, Anderson DE. Sustained increased cerebral blood flow with prophylactic hypertensive hypervolemic hemodilution (“triple-H” therapy) after subarachnoid hemorrhage. Neurosurgery 1990;27:729–740.

    Article  PubMed  CAS  Google Scholar 

  7. Elliott JP, Newell DW, Lam DJ, et al. Comparison of balloon angioplasty and papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 1998;88:277–284.

    PubMed  CAS  Google Scholar 

  8. Eskridge JM, McAuliffe W, Song JK, et al. Balloon angioplasty for the treatment of vasospasm: results of first 50 cases. Neurosurgery 1998;42:510–517.

    Article  PubMed  CAS  Google Scholar 

  9. Newell DW, Eskridge JM, Mayberg MR, Grady MS, Winn HR. Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg 1989;71:654–660.

    PubMed  CAS  Google Scholar 

  10. Rosenwasser RH, Armonda RA, Thomas JE, Benitez RP, Gannon PM, Harrop J. Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options. Neurosurgery 1999;44:975–980.

    Article  PubMed  CAS  Google Scholar 

  11. Milburn JM, Moran CJ, Cross DT III, Diringer MN, Pilgram TK, Dacey RG Jr. Increase in diameters of vasospastic intracranial arteries by intra-arterial papaverine administration. J Neurosurg 1998;88:38–42.

    PubMed  CAS  Google Scholar 

  12. Kassell NF, Boarini DJ, Adams HP Jr, et al. Overall management of ruptured aneurysm: comparison of early and late operation [Journal Article] Neurosurgery. 1981;9(2):120–128.

    Article  PubMed  CAS  Google Scholar 

  13. Grossett DG, Straiton J, du Trevon M, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes. Stroke 1992;23:674–679.

    Google Scholar 

  14. Gruber A, Ungersbock K, Reinprecht A, et al. Evaluation of cerebral vasospasm after early surgical and endovascular treatment of ruptured intracranial aneurysms. Neurosurgery 1998;42:258–268.

    Article  PubMed  CAS  Google Scholar 

  15. Kassell NF, Torner JC, Haley EC, et al. The International Cooperative Study on the timing of aneurysm surgery, I: overall management results. J Neurosurg 1990;73:18–36.

    PubMed  CAS  Google Scholar 

  16. Turjman F, Mimon S, Yilmaz H. Epidémiologie, étude clinique et anatomopathologie du vasospasme. J Neuroradiol 1999;26:1S10–1S16.

    Google Scholar 

  17. Boncoeur MP, Turjman F. Imagerie du vasospasme. J Neuroradiol 1999;26:1S17–1S21.

    Google Scholar 

  18. Aaslid R. Developments and principles of transcranial Doppler. In: Newell DW, Aaslid R (eds). Transcranial Doppler. Raven Press, New York, NY, 1992, pp. 1–8.

    Google Scholar 

  19. Aaslid R, Huber P, Nornes H. Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 1984;60:37–41.

    PubMed  CAS  Google Scholar 

  20. Compton JS, Redmond S, Symon L. Cerebral blood velocity in subarachnoid hemorrhage: A transcranial Doppler study. J Neurol Neurosurg Psychiatry 1987;50:1499–1503.

    Article  PubMed  CAS  Google Scholar 

  21. Creissard P, Proust F, Langlois O. Vasospasm diagnosis: theoretical and real transcranial Doppler sensitivity. Acta Neurochir (Wien) 1995;136:181–185.

    Article  CAS  Google Scholar 

  22. Grosset DG, Straiton J, McDonald I, Bullock R. Angiographic and Doppler diagnosis of cerebral artery vasospasm following subarachnoid hemorrhage. Br J Neurosurg 1993;7:291–298.

    PubMed  CAS  Google Scholar 

  23. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm after subarachnoid hemorrhage investigated by means of transcranial Doppler ultrasound. Acta Neurochir (Wien) 1988;42:81–84.

    CAS  Google Scholar 

  24. Lindegaard K-F, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 1989;100:12–24.

    Article  CAS  Google Scholar 

  25. Grosset DG, McDonald I, Cockburn M, Straiton J, Bullock RR. Prediction of delayed neurological deficit after subarachnoid hemorrhage: A CT blood load and Doppler velocity approach. Neuroradiology 1994;36:418–421.

    Article  PubMed  CAS  Google Scholar 

  26. Romner B, Bellner J, Kongstad P, Sjoholm H. Elevated transcranial Doppler flow velocities after severe head injury: Cerebral vasospasm or hyperemia? J Neurosurg 1996;85:90–97.

    PubMed  CAS  Google Scholar 

  27. Powsner RA, O’Tuama LA, Jabre A, et al. SPECT imaging in cerebral vasospasm following subarachnoid hemorrhage. J Nucl Med 1998;39:765.

    PubMed  CAS  Google Scholar 

  28. Soucy JP, McNamara D, Mohr G, et al. Evaluation of vasospasm secondary to subarachnoid hemorrhage with technetium 99m-hexamethyl-propyleneamine oxime (HMPAO) tomoscintigraphy. J Nucl Med 1990;31:972.

    PubMed  CAS  Google Scholar 

  29. Clyde BL, Resnick DK, Yonas H, Smith HA, Kaufmann AM. The relationship of blood velocity as measured by transcranial Doppler ultrasonography to cerebral blood flow as determined by stable xenon computed tomographic studies after aneurysmal subarachnoid hemorrhage. Neurosurgery 1996;38:896–905.

    Article  PubMed  CAS  Google Scholar 

  30. Ekelund A, Saveland H, Romner B, Brandt L. Is transcranial Doppler sonography useful in detecting late cerebral ischemia after aneurysmal subarachnoid hemorrhage? Br J Neurosurg 1996;10:19–25.

    Article  PubMed  CAS  Google Scholar 

  31. Lysakowski C, Walder B, Costanza MC, Tramer MR. Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm; a systematic review. Stroke 2001;32:2292–2298.

    PubMed  CAS  Google Scholar 

  32. Okada Y, Shima T, Nishida M, et al. Comparison of transcranial Doppler investigation of aneurysmal vasospasm with digital subtraction angiographic and clinical findings. [Journal Article] Neurosurgery 1999;45(3):443–449; discussion 449,450.

    PubMed  CAS  Google Scholar 

  33. Vora YY, Suarez-Almazor Maria, Steinke DE, Martin ML, Findllay M. Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 1999;44(6):1237–1247.

    Article  Google Scholar 

  34. Torbey MT, Hauser TK, Bhardwaj A, et al. Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurismal subarachnoid hemorrhage. Stroke 2001;32(9):2005–2011.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA

    Neeraj S. Naval, Carole E. Thomas & Victor C. Urrutia

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  1. Neeraj S. Naval
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Correspondence to Neeraj S. Naval.

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Naval, N.S., Thomas, C.E. & Urrutia, V.C. Relative changes in flow velocities in vasospasm after subarachnoid hemorrhage. Neurocrit Care 2, 133–140 (2005). https://doi.org/10.1385/NCC:2:2:133

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