Philipp Gölitz1, Philip Hoelter2, Julie Rösch2, Karl Roessler3, Frauke Knossalla4, Arnd Doerfler2. 1. Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. philipp.goelitz@uk-erlangen.de. 2. Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. 3. Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany. 4. Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
Abstract
PURPOSE: Delayed cerebral ischemia (DCI) still remains a major complication after subarachnoid hemorrhage (SAH). The aim of our study was to evaluate whether flow analysis of admission digital subtraction angiography (DSA) using parametric color coding (PCC), a postprocessing algorithm, allows ultra-early identification of SAH patients at risk for developing subsequent symptomatic vasospasm. METHODS: In this study 52 patients who suffered SAH from aneurysm rupture, were retrospectively enrolled. Of the patients 26 developed DCI and angiographically proven cerebral vasospasm and 26 age, gender-and clinical status-matched SAH patients without DCI served as controls. Using PCC, the following flow parameters were calculated: cerebral circulation time (CirT), cortical relative time to peak (rTTP) and microvascular transit time (TT). RESULTS: Mean cerebral CirT and cortical rTTP were longer in the DCI group (6.42 s ± 1.54 and 3.16 s ± 0.86, respectively) than in the non-DCI group (5.77 s ± 1.86 and 3.11 s ± 1.41, respectively), but without statistical significance. The mean microvascular TT was statistically significantly (p = 0.04) longer in the DCI group (3.19 s ± 0.78) than in the non-DCI group (2.67 s ± 0.73). CONCLUSION: Angiographic flow analysis might be suitable for ultra-early detection and quantitative assessment of microcirculatory injury in SAH patients, predictive of developing subsequent DCI. Prolonged microvascular TT seems to be a significant independent factor positively associated with DCI development. Identifying SAH patients at risk for DCI ultra-early after ictus might contribute to initiate prophylactic therapies before clinical deterioration.
PURPOSE:Delayed cerebral ischemia (DCI) still remains a major complication after subarachnoid hemorrhage (SAH). The aim of our study was to evaluate whether flow analysis of admission digital subtraction angiography (DSA) using parametric color coding (PCC), a postprocessing algorithm, allows ultra-early identification of SAHpatients at risk for developing subsequent symptomatic vasospasm. METHODS: In this study 52 patients who suffered SAH from aneurysm rupture, were retrospectively enrolled. Of the patients 26 developed DCI and angiographically proven cerebral vasospasm and 26 age, gender-and clinical status-matched SAHpatients without DCI served as controls. Using PCC, the following flow parameters were calculated: cerebral circulation time (CirT), cortical relative time to peak (rTTP) and microvascular transit time (TT). RESULTS: Mean cerebral CirT and cortical rTTP were longer in the DCI group (6.42 s ± 1.54 and 3.16 s ± 0.86, respectively) than in the non-DCI group (5.77 s ± 1.86 and 3.11 s ± 1.41, respectively), but without statistical significance. The mean microvascular TT was statistically significantly (p = 0.04) longer in the DCI group (3.19 s ± 0.78) than in the non-DCI group (2.67 s ± 0.73). CONCLUSION: Angiographic flow analysis might be suitable for ultra-early detection and quantitative assessment of microcirculatory injury in SAHpatients, predictive of developing subsequent DCI. Prolonged microvascular TT seems to be a significant independent factor positively associated with DCI development. Identifying SAHpatients at risk for DCI ultra-early after ictus might contribute to initiate prophylactic therapies before clinical deterioration.
Authors: Satoshi Iwabuchi; M Hayashi; T Yokouchi; K Sato; H Nakayama; J Harashina; J Iwama; M Ishii; Y Hiramoto; N Hirai; Y Hirata; N Saito; K Ito; H Kimura; K Aoki Journal: Acta Neurochir Suppl Date: 2015
Authors: Jan Willem Dankbaar; Nicolien Karen de Rooij; Mienke Rijsdijk; Birgitta K Velthuis; Catharine J M Frijns; Gabriel J E Rinkel; Irene C van der Schaaf Journal: Stroke Date: 2010-08-05 Impact factor: 7.914
Authors: P C Sanelli; I Ugorec; C E Johnson; J Tan; A Z Segal; M Fink; L A Heier; A J Tsiouris; J P Comunale; M John; P E Stieg; R D Zimmerman; A I Mushlin Journal: AJNR Am J Neuroradiol Date: 2011-09-29 Impact factor: 3.825
Authors: Andrew J Molyneux; Richard S C Kerr; Ly-Mee Yu; Mike Clarke; Mary Sneade; Julia A Yarnold; Peter Sandercock Journal: Lancet Date: 2005 Sep 3-9 Impact factor: 79.321
Authors: Kevin A Shah; Timothy G White; Keren Powell; Henry H Woo; Raj K Narayan; Chunyan Li Journal: Neurosurgery Date: 2022-04-01 Impact factor: 5.315