Dabecco Rocco, Gigliotti Michael J, Mao Gordon, Browning Sarah, Hertz Steven, Lew Sungyub
Neurosurgery, Allegheny Health Network, Pittsburgh, USA.
Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2021 Feb 28;13(2):e13605. doi: 10.7759/cureus.13605.
Background Cerebral vasospasm has been monitored by conventional angiography or transcranial Doppler (TCD). While angiography is the most accurate and reliable method for detection, TCDs are a noninvasive alternative to monitor onset and resolution of vasospasm. We aim to determine whether alternative TCD parameters rather than Lindegaard ratio lead to an improved method to diagnose and potentially prevent cerebral vasospasm. Methods A total of 103 consecutive patients with subarachnoid hemorrhage (SAH) were retrospectively reviewed and TCD studies were performed during the first 14 days post-bleed or longer if indicated. Multivariate logistic regression models were developed using significant univariate characteristics. Receiver operating characteristic (ROC) curves evaluated the mean middle cerebral artery (MCA), peak systolic MCA (PSV MCA), and end diastolic MCA (EDV MCA) velocities as well as ratios when compared to the ipsilateral extracranial internal carotid artery (ICA). The area under the curve was calculated to compare accuracy for symptomatic vasospasm. Results Thirteen patients (12.6%) were observed to develop cerebral vasospasm. Aneurysm location (p = 0.51), Hunt and Hess grade (p = 0.44), Fischer grade (p = 0.87), comorbidities, age (p = 0.67), or gender (p = 0.41) did not appear to have any effect in predicting the presence of vasospasm. ROC curves demonstrated that MCA EDV appeared to be slightly better compared to MCA velocity in predicting symptomatic vasospasm. PSV MCA/extracranial ICA and the EDV MCA/extracranial ICA ratios appeared to be an improvement to the Lindegaard ratio in the prediction of symptomatic vasospasm. Conclusion The utility of peak systolic and end diastolic velocities, instead of the classically referenced mean velocities and Lindegaard ratio, may improve diagnostic sensitivity of cerebral vasospasm after subarachnoid hemorrhage.
脑动脉痉挛一直通过传统血管造影术或经颅多普勒（TCD）进行监测。虽然血管造影术是检测脑动脉痉挛最准确、最可靠的方法，但TCD是监测血管痉挛发生和缓解的一种非侵入性替代方法。我们旨在确定是否采用替代的TCD参数而非林德加德比值能改进诊断方法，并有可能预防脑动脉痉挛。方法：回顾性分析103例连续的蛛网膜下腔出血（SAH）患者，在出血后的前14天或必要时更长时间内进行TCD检查。利用显著的单变量特征建立多变量逻辑回归模型。通过绘制受试者工作特征（ROC）曲线，评估大脑中动脉（MCA）的平均血流速度、收缩期峰值血流速度（PSV MCA）和舒张末期血流速度（EDV MCA），以及与同侧颅外颈内动脉（ICA）相比的比值。计算曲线下面积以比较有症状血管痉挛的诊断准确性。结果：观察到13例患者（12.6%）发生脑动脉痉挛。动脉瘤位置（p = 0.51）、Hunt和Hess分级（p = 0.44）、Fischer分级（p = 0.87）、合并症、年龄（p = 0.67）或性别（p = 0.41）在预测血管痉挛的存在方面似乎没有任何影响。ROC曲线表明，在预测有症状血管痉挛方面，MCA的EDV似乎比MCA血流速度略好。PSV MCA/颅外ICA和EDV MCA/颅外ICA比值在预测有症状血管痉挛方面似乎比林德加德比值有所改进。结论：与经典引用的平均血流速度和林德加德比值相比，收缩期峰值血流速度和舒张末期血流速度可能提高蛛网膜下腔出血后脑动脉痉挛的诊断敏感性。
