Claudio E Scherle Matamoros1,2, Edgar A Samaniego3, Kimberly Sam2, Jorge A Roa4, Jesús Pérez Nellar5, Danny Rivero Rodríguez1,2. 1. School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador. 2. Department of Neurology, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador. 3. Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. 4. Department of Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. 5. Department of Neurology, Hospital Clínico-Quirúrgico Hermanos Ameijeiras, Havana, Cuba.
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. All Rights Reserved by JVIN. Unauthorized reproduction of this article is prohibited.
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. All Rights Reserved by JVIN. Unauthorized reproduction of this article is prohibited.
Authors: Timothy J Kaufmann; John Huston; Jay N Mandrekar; Cathy D Schleck; Kent R Thielen; David F Kallmes Journal: Radiology Date: 2007-06 Impact factor: 11.105