Lyman Kyle A, Rubin Daniel B, Regenhardt Robert W, Webb Andrew J, Rordorf Guy A, Edlow Brian L, Kimberly W Taylor, Du Rose, Snider Samuel B, Stapleton Christopher J, Patel Aman B, Locascio Joseph J, Bevers Matthew B, Wu Ona, Chung David Y
Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
J Cereb Blood Flow Metab. 2025 Jul 28:271678X251361992. doi: 10.1177/0271678X251361992.
Aneurysmal subarachnoid hemorrhage (aSAH) contributes disproportionately to stroke-related disability due to its prevalence in younger patients. Large vessel vasospasm complicates aSAH and is often treated with endovascular rescue therapy (ERT). However, clinical trials have not demonstrated a clear link between vasospasm improvement and better outcomes. We hypothesized that improving vessel caliber alone may not ensure better blood flow to brain parenchyma, and we studied how vessel caliber relates to perfusion in the context of ERT. We measured the internal carotid artery (ICA) caliber and time to maximum of the residual function (Tmax) from digital subtraction angiography (DSA) before and after ERT in 150 vessels from 36 patients. ERT increased ICA caliber (Δ1.13 ± 3.8 mm, p < 0.01) and accelerated mean Tmax (Δ-215 ± 483 ms, p < 0.01). The percent change in ICA caliber with ERT was weakly correlated with the change in Tmax (R = 0.04, p < 0.01). In contrast, Tmax before ERT strongly predicted Tmax after ERT (R = 0.62, p < 0.01) in both univariate and multivariable models. We conclude that a perfusion metric (Tmax) is superior to vessel caliber in predicting the response to ERT. Validating these findings may shift the clinical focus from vessel caliber to perfusion metrics when evaluating vasospasm and aSAH outcomes.
由于动脉瘤性蛛网膜下腔出血（aSAH）在年轻患者中更为常见，因此它对与中风相关的残疾所起的作用不成比例。大血管痉挛使aSAH病情复杂化，通常采用血管内抢救治疗（ERT）。然而，临床试验尚未证明血管痉挛改善与更好的预后之间存在明确联系。我们推测，仅改善血管管径可能无法确保更好地向脑实质供血，因此我们研究了在ERT背景下血管管径与灌注之间的关系。我们测量了36例患者150条血管在ERT前后的数字减影血管造影（DSA）中的颈内动脉（ICA）管径和残余功能达到最大值的时间（Tmax）。ERT增加了ICA管径（Δ1.13±3.8mm，p<0.01）并加快了平均Tmax（Δ-215±483ms，p<0.01）。ERT引起的ICA管径变化百分比与Tmax变化呈弱相关（R=0.04，p<0.01）。相比之下，在单变量和多变量模型中，ERT前的Tmax都能强烈预测ERT后的Tmax（R=0.62，p<0.01）。我们得出结论，在预测对ERT的反应方面，灌注指标（Tmax）优于血管管径。验证这些发现可能会在评估血管痉挛和aSAH预后时将临床重点从血管管径转移到灌注指标上。
