Kim Yongwoo, Kim Alexander, Williams Josef D, Withington Charles, Tefera Eshetu, Gizaw Samrawit, Felbaum Daniel R, Mai Jeffrey C, Liu Ai-Hsi, Armonda Rocco A, Chang Jason J
Comrehensive Stroke Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
Department of Neurology, Georgetown University School of Medicine, Washington, District of Columbia, USA.
J Neuroimaging. 2025 Jan-Feb;35(1):e70010. doi: 10.1111/jon.70010.
While the pulsatility index (PI) measured by transcranial Doppler (TCD) has broader associations with outcomes in neurocritical care, its use in monitoring delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH) is not endorsed by current clinical guidelines. Recognizing that arterial pressure gradient (ΔP) can be estimated using PI, we investigated the potential significance of TCD-estimated ΔP.
In this observational study of 186 SAH patients, we recorded the mean cerebral blood flow velocity (mCBFV) and PI values from the middle cerebral artery, along with corresponding blood pressures. Using a previously reported mathematical model, we estimated ΔP by dividing pulse pressure by PI. We investigated the association between ΔP and mCBFV values and two acute phase complications of SAH-DCI and angiographic vasospasm. Additionally, we explored the association between DCI, vasospasm, and 90-day functional outcome.
Elevated ΔP was associated with DCI (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.004-1.039, p = 0.014) but not vasospasm (OR 1.006, 95% CI 0.991-1.022, p = 0.402). Elevated mCBFV was associated with vasospasm (OR 1.037, 95% CI 1.017-1.057, p < 0.001) but not DCI (OR 0.998, 95% CI 0.979-1.018, p = 0.873). DCI (OR 29.380, 95% CI 2.930-294.615, p = 0.004), rather than vasospasm (OR 0.695, 95% CI 0.120-4.043, p = 0.686), was associated with functional outcome.
Increased ΔP, rather than elevated mCBFV, was associated with DCI. While elevated mCBFV was associated with vasospasm, it was not associated with DCI. Hence, TCD-estimated ΔP may serve as a predictor for the DCI in SAH patients, a condition that impacts long-term outcome.
虽然经颅多普勒（TCD）测量的搏动指数（PI）与神经重症监护中的预后有更广泛的关联，但目前临床指南并不认可将其用于监测动脉瘤性蛛网膜下腔出血（SAH）患者的迟发性脑梗死（DCI）。鉴于动脉压梯度（ΔP）可通过PI进行估算，我们研究了TCD估算的ΔP的潜在意义。
在这项对186例SAH患者的观察性研究中，我们记录了大脑中动脉的平均脑血流速度（mCBFV）和PI值，以及相应的血压。使用先前报道的数学模型，我们通过将脉压除以PI来估算ΔP。我们研究了ΔP与mCBFV值以及SAH的两种急性期并发症——DCI和血管造影血管痉挛之间的关联。此外，我们还探讨了DCI、血管痉挛与90天功能预后之间的关联。
ΔP升高与DCI相关（优势比[OR]1.021，95%置信区间[CI]1.004 - 1.039，p = 0.014），但与血管痉挛无关（OR 1.006，95% CI 0.991 - 1.022，p = 0.402）。mCBFV升高与血管痉挛相关（OR 1.037，95% CI 1.017 - 1.057，p < 0.001），但与DCI无关（OR 0.998，95% CI 0.979 - 1.018，p = 0.873）。与功能预后相关的是DCI（OR 29.380，95% CI 2.930 - 294.615，p = 0.004），而非血管痉挛（OR 0.695，95% CI 0.120 - 4.043，p = 0.686）。
ΔP升高而非mCBFV升高与DCI相关。虽然mCBFV升高与血管痉挛相关，但与DCI无关。因此，TCD估算的ΔP可能作为SAH患者DCI的预测指标，DCI会影响长期预后。
