Sathialingam Eashani, Cowdrick Kyle R, Liew Amanda Y, Fang Zhou, Lee Seung Yup, McCracken Courtney E, Akbik Feras, Samuels Owen B, Kandiah Prem, Sadan Ofer, Buckley Erin M
Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States.
Department of Electrical and Computer Engineering, Kennesaw State University, Marietta, GA, United States.
Front Neurol. 2023 Mar 17;14:1052232. doi: 10.3389/fneur.2023.1052232. eCollection 2023.
One of the common complications of non-traumatic subarachnoid hemorrhage (SAH) is delayed cerebral ischemia (DCI). Intrathecal (IT) administration of nicardipine, a calcium channel blocker (CCB), upon detection of large-artery cerebral vasospasm holds promise as a treatment that reduces the incidence of DCI. In this observational study, we prospectively employed a non-invasive optical modality called diffuse correlation spectroscopy (DCS) to quantify the acute microvascular cerebral blood flow (CBF) response to IT nicardipine (up to 90 min) in 20 patients with medium-high grade non-traumatic SAH. On average, CBF increased significantly with time post-administration. However, the CBF response was heterogeneous across subjects. A latent class mixture model was able to classify 19 out of 20 patients into two distinct classes of CBF response: patients in Class 1 ( = 6) showed no significant change in CBF, while patients in Class 2 ( = 13) showed a pronounced increase in CBF in response to nicardipine. The incidence of DCI was 5 out of 6 in Class 1 and 1 out of 13 in Class 2 ( < 0.001). These results suggest that the acute (<90 min) DCS-measured CBF response to IT nicardipine is associated with intermediate-term (up to 3 weeks) development of DCI.
非创伤性蛛网膜下腔出血（SAH）的常见并发症之一是迟发性脑缺血（DCI）。在检测到大脑大动脉血管痉挛时鞘内注射（IT）钙通道阻滞剂（CCB）尼卡地平，有望成为一种降低DCI发生率的治疗方法。在这项观察性研究中，我们前瞻性地采用了一种名为扩散相关光谱学（DCS）的非侵入性光学方法，对20例中高等级非创伤性SAH患者鞘内注射尼卡地平后急性微血管脑血流量（CBF）的反应（长达90分钟）进行量化。平均而言，给药后CBF随时间显著增加。然而，不同受试者的CBF反应存在异质性。一个潜在类别混合模型能够将20例患者中的19例分为两类不同的CBF反应：第1类（n = 6）患者的CBF无显著变化，而第2类（n = 13）患者的CBF在注射尼卡地平后显著增加。第1类中6例有5例发生DCI，第2类中13例有1例发生DCI（P < 0.001）。这些结果表明，鞘内注射尼卡地平后急性（<90分钟）DCS测量的CBF反应与DCI的中期（长达3周）发展相关。
