Key result
Higher ipsilateral cerebral blood flow velocity slow waves before vasospasm were significantly predictive of delayed cerebral ischemia (OR 2.52, 95% CI 1.05-6.02).
Why the study?
The potential association between indices of cerebrovascular dynamics and the development of delayed cerebral ischemia following subarachnoid hemorrhage remains elusive.
Does the magnitude of transcranial doppler blood flow velocity slow waves predict delayed cerebral ischemia in patients with subarachnoid hemorrhage?
Cohort (n=32)
No
Does the magnitude of transcranial doppler blood flow velocity slow waves predict delayed cerebral ischemia in patients with subarachnoid hemorrhage?
Odds Ratio: 2.52 (95% CI 1.05–6.02)
p-value: p=0.02
Higher magnitude of transcranial doppler-detected slow waves of cerebral blood flow velocity before vasospasm can predict the development of delayed cerebral ischemia in patients with subarachnoid hemorrhage.
Higher pre-VS CBFV slow waves were associated with DCI; hypothesis-generating for TCD indices in SAH risk stratification.
BackgroundCerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial doppler (TCD)-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia.MethodsA retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in 2 groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Complexity of CBFV was estimated through measurement of sample entropy (SampEn). ResultsIn the whole population (N=32), magnitude of SWs of ipsilateral to VS side CBFV was higher during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/sec, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group ( N =19, p < 0.001) and were strongly predictive of DCI, with area under the curve (AUC) = 0.745 (p = 0.02). Vasospasm caused a non-significant shortening of ipsilateral values of tau and increase in SampEn in all patients related to pre VS measurements, as well as an insignificant increase of Mxa in DCI related to non-DCI group (N = 13).ConclusionsIn patients suffering from subarachnoid hemorrhage, TCD-detected VS was associated with higher ipsilateral CBFV SWs, related to pre-VS measurements. Higher CBFV SWs before VS were significantly predictive of delayed cerebral ischemia.
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Papaioannou et al. (2021) conducted a cohort in Subarachnoid Hemorrhage with Vasospasm (n=32). Pre-vasospasm slow waves of cerebral blood flow velocity vs. Lower slow wave magnitude was evaluated on Prediction of delayed cerebral ischemia (OR 2.52, 95% CI 1.05-6.02, p=0.02). Higher ipsilateral cerebral blood flow velocity slow waves before vasospasm were significantly predictive of delayed cerebral ischemia (OR 2.52, 95% CI 1.05-6.02).
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