Creissard P, Proust F, Langlois O
Department of Neurosurgery, Centre Hospitalier Universitaire, Rouen, France.
Acta Neurochir (Wien). 1995;136(3-4):181-5. doi: 10.1007/BF01410623.
In 40 patients middle cerebral artery trunk (M1) flow velocity was recorded just before 54 carotid angiography in 54 cases exhibiting vasospasm after aneurysm rupture. Angiographic vasospasm distribution was studied; cases of symptomatic vasospasm were noted and were compared with transcranial Doppler data. Angiographic vasospasm was present in M1 in 41/54 carotid angiograms. Postulating that all the cases of M1 angiographic vasospasm should be identified by transcranial Doppler, the theoretical sensitivity of TCD was 76%. In this series however the real sensitivity of TCD in vasospasm diagnosis was only 70%: besides 13 cases where vasospasm was not present in M1 (mainly after ACoA Aneurysm rupture), TCD failed to identify 3 cases of M1 angiographic vasospasm. Vasospasm may not be located in M1 even when severe and symptomatic (4 cases in this series). Transcranial Doppler remains a mediocre tool for identifying vasospasm after anterior communicating artery aneurysm rupture (sensitivity: 55%). Its reliability is better after internal carotid aneurysm rupture (sensitivity: 72%) and excellent after middle cerebral artery aneurysm rupture (sensitivity: 93%). In order to test the drugs or methods used to prevent or combat vasospasm, angiography has to be considered when during the vasospasm risk period TCD does not demonstrate vasospasm in M1, either in patients in whom clinical deterioration is occurring without other obvious explanation, or in all patients.
在54例动脉瘤破裂后出现血管痉挛的患者中，对40例患者在进行54次颈动脉血管造影之前记录了大脑中动脉主干（M1）的血流速度。研究了血管造影血管痉挛的分布情况；记录了有症状血管痉挛的病例，并将其与经颅多普勒数据进行比较。在54例颈动脉血管造影中，41例M1出现血管造影血管痉挛。假设所有M1血管造影血管痉挛病例都能通过经颅多普勒识别出来，经颅多普勒的理论敏感性为76%。然而，在本系列研究中，经颅多普勒在血管痉挛诊断中的实际敏感性仅为70%：除了13例M1未出现血管痉挛的病例（主要是前交通动脉瘤破裂后），经颅多普勒未能识别出3例M1血管造影血管痉挛病例。即使血管痉挛严重且有症状，也可能不在M1部位（本系列中有4例）。经颅多普勒仍然是一种用于识别前交通动脉瘤破裂后血管痉挛的中等工具（敏感性：55%）。其在颈内动脉瘤破裂后的可靠性较好（敏感性：72%），在大脑中动脉瘤破裂后则非常出色（敏感性：93%）。为了测试用于预防或对抗血管痉挛的药物或方法，在血管痉挛风险期，如果经颅多普勒在M1未显示血管痉挛，对于临床病情恶化且无其他明显原因的患者，或所有患者，都必须考虑进行血管造影。
