Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Clinical Neurosciences, University of Cambridge, Cambridge, UK.
J Neurointerv Surg. 2022 Nov;14(11):1107-1111. doi: 10.1136/neurintsurg-2021-018080. Epub 2021 Nov 5.
Cone-beam CT angiography (CB-CTA) provides a three-dimensional spatial resolution which is, so far, unmatched in clinical practice compared with other conventional techniques such as two-dimensional digital subtracted angiography. We aimed to assess the distribution of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) using CB-CTA.
30 consecutive patients with aSAH undergoing vasospasm percutaneous balloon angioplasty (PBA) were recruited and underwent CB-CTA in this single-center prospective cohort series. Intracranial arteries were systematically analyzed by two independent observers from the large trunks to the distal cortical branches and perforators using a high-resolution reconstruction protocol. Intermediate and severe cerebral vasospasm was defined as 30-50% and >50% narrowing in the diameter of the vessel, respectively.
35 arterial cervical artery territories were analyzed, of which 80% were associated with clinical or radiological signs of delayed cerebral ischemia. The median spatial resolution was 150 µm (range 100-250 µm). Intermediate or severe vasospasm was observed in the proximal (86%, 95% CI 74% to 97%), middle (89%, 95% CI 78% to 99%), and distal (60%, 95% CI 44% to 76%) segments of the large trunks, as well as the cortical branches (11%, 95% CI 1% to 22%). No vasospasm was observed in basal ganglia or cortical perforators, or in arteries smaller than 900 µm. Vasospasm was more severe in middle or distal segments compared with proximal segments in 43% (95% CI 26% to 59%) of cases.
Our study demonstrated that symptomatic cerebral vasospasm following aSAH did not involve arteries smaller than 900 µm, and frequently predominated in middle or distal segments. These results offer new insights into the potential management options for vasospasm using PBA.
与二维数字减影血管造影等其他常规技术相比，锥形束 CT 血管造影（CB-CTA）提供了迄今为止无与伦比的三维空间分辨率。我们旨在使用 CB-CTA 评估蛛网膜下腔出血（aSAH）后症状性脑血管痉挛的分布。
本单中心前瞻性队列研究纳入了 30 例接受血管痉挛经皮球囊血管成形术（PBA）的 aSAH 患者，并对其进行了 CB-CTA 检查。两名独立观察者使用高分辨率重建方案，从大血管干到远端皮质分支和穿支动脉，对颅内动脉进行系统分析。中度和重度脑血管痉挛定义为血管直径狭窄 30%-50%和>50%。
共分析了 35 个颈内动脉区域，其中 80%与迟发性脑缺血的临床或影像学征象相关。中位空间分辨率为 150μm（范围 100-250μm）。近端（86%，95%CI 74%-97%）、中段（89%，95%CI 78%-99%）和远端（60%，95%CI 44%-76%）大血管干以及皮质分支均观察到中度或重度血管痉挛。基底节区或皮质穿支动脉或直径小于 900μm 的动脉未见血管痉挛。43%（95%CI 26%-59%）的病例中，中段或远端段的血管痉挛比近端段更严重。
我们的研究表明，aSAH 后症状性脑血管痉挛不累及直径小于 900μm 的动脉，且常以中或远端段为主。这些结果为使用 PBA 治疗血管痉挛的潜在治疗选择提供了新的见解。
