Doppler ultrasound measurement of blood flow volume in the extracranial internal carotid artery for evaluation of brain perfusion after aneurysmal subarachnoid hemorrhage.

Monitoring of cerebral blood flow (CBF) is an essential part in the early diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Several methods have been established to monitor cerebral perfusion in these patients. During last few years, a new sonographic approach has been introduced, the so called 'angle independent ultrasound system' for monitoring volume flow in the internal carotid artery (ICA). The angle independent Doppler ultrasound system Quantix ND (Cardiosonix Ltd, Israel) determines the diameter of the ICA as well as the velocity of blood flow in the extracranial part of this vessel. Thus, a determination of the global CBF in the anterior circulation can be achieved. Aim of our study was to compare the Quantix ND system and the commonly used transcranial Doppler sonography (TCD) in patients suffering from aneurysmal SAH. We included 11 patients (eight female and three male; Hunt and Hess I-V) and performed post-operatively/post-interventionally daily measurement of blood flow volume in the ICA, and determined the blood flow velocity in middle and anterior cerebral artery (MCA and ACA) with TCD. Six patients post-operatively/post-interventionally developed cerebral vasospasm, resulting in ischemia and territorial infarction. Three patients were chosen as case studies. In contrast to the TCD, we found a strong significant correlation of blood flow volume with Quantix ND in the ICA and the occurrence of cerebral infarction (p<0.001). These preliminary data justify further investigation of this angle independent Doppler ultrasound device. We postulate that this new tool might be effective for monitoring the CBF in the critical post-operative/post-interventional interval following aneurysmal SAH.