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Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage

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Subarachnoid Hemorrhage

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 127))

Abstract

Background: Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV).

Methods: Eight SAH patients underwent prospectively a median of 7 DCA assessments consisting of continuous measurements of BCFV and BP. Transfer function analysis was applied to calculate average phase shift (PS) in low (0.07–0.2 Hz) frequency range for each hemisphere as continuous measure of DCA. Lower PS indicated poorer regulatory response. DCI was defined as a 2-point decrease in Glasgow Coma Score and/or infarction on CT.

Results: Three subjects developed symptomatic vasospasm with median time-to-DCI of 9 days. DCI was significantly associated with lower PS over the entire recording period (Wald = 4.28; p = 0.039). Additionally, there was a significant change in PS over different recording periods after adjusting for DCI (Wald = 15.66; p = 0.001); particularly, a significantly lower mean PS day 3–5 after bleed (14.22 vs 27.51; p = 0.05).

Conclusions: DCA might be useful for early detection of symptomatic vasospasm. A larger cohort study of SAH patients is currently underway.

Presentation at a conference: 14th International Conference on Neurovascular Events after Subarachnoid Hemorrhage or Vasospasm 2017.

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Abbreviations

ABP:

Arterial blood pressure

aSAH:

Aneurysmal subarachnoid hemorrhage

CBF:

Cerebral blood flow

CBFV:

Cerebral blood flow velocity

CPP:

Cerebral perfusion pressure

CT:

Computerized tomography

CTA:

Computerized tomography angiogram

DCA:

Dynamic cerebral autoregulation

DCI:

Delayed cerebral ischemia

EBI:

Early brain injury

FFT:

Fast Fourier transformed

GCS:

Glasgow Coma Scale

GEE:

Generalized estimating equations

MAP:

Mean arterial pressure

MCA:

Middle cerebral artery

TCD:

Transcranial Doppler

References

  1. Al-Shahi R, White PM, Davenport RJ, Lindsay KW. Subarachnoid haemorrhage. BMJ. 2006;333:235–40. https://doi.org/10.1136/bmj.333.7561.235.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Baggott CD, Aagaard-Kienitz B. Cerebral vasospasm. Neurosurg Clin N Am. 2014;25:497–528. https://doi.org/10.1016/j.nec.2014.04.008.

    Article  PubMed  Google Scholar 

  3. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH, American Heart Association. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40:994–1025. https://doi.org/10.1161/STROKEAHA.108.191395.

    Article  PubMed  Google Scholar 

  4. Budohoski KP, Czosnyka M, Smielewski P, Kasprowicz M, Helmy A, Bulters D, Pickard JD, Kirkpatrick PJ. Impairment of cerebral autoregulation predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective observational study. Stroke. 2012;43:3230–7. https://doi.org/10.1161/STROKEAHA.112.669788.

    Article  PubMed  Google Scholar 

  5. Carrera E, Schmidt JM, Oddo M, Ostapkovich N, Claassen J, Rincon F, Seder D, Gordon E, Kurtz P, Lee K, Connolly ES, Badjatia N, Mayer SA. Transcranial Doppler ultrasound in the acute phase of aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis. 2009;27:579–84. https://doi.org/10.1159/000214222.

    Article  PubMed  Google Scholar 

  6. Dohmen C, Bosche B, Graf R, Reithmeier T, Ernestus RI, Brinker G, Sobesky J, Heiss WD. Identification and clinical impact of impaired cerebrovascular autoregulation in patients with malignant middle cerebral artery infarction. Stroke. 2007;38:56–61. https://doi.org/10.1161/01.STR.0000251642.18522.b6.

    Article  PubMed  Google Scholar 

  7. Dorsch NW, King MT. A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage part I: incidence and effects. J Clin Neurosci. 1994;1:19–26.

    Article  CAS  Google Scholar 

  8. Frontera JA, Fernandez A, Schmidt JM, Claassen J, Wartenberg KE, Badjatia N, Connolly ES, Mayer SA. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke. 2009;40:1963–8. https://doi.org/10.1161/STROKEAHA.108.544700.

    Article  PubMed  Google Scholar 

  9. Hijdra A, Van Gijn J, Stefanko S, Van Dongen KJ, Vermeulen M, Van Crevel H. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. Neurology. 1986;36:329–33.

    Article  CAS  Google Scholar 

  10. Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997;28:660–4.

    Article  CAS  Google Scholar 

  11. Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL. The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg. 1990;73:18–36. https://doi.org/10.3171/jns.1990.73.1.0018.

    Article  CAS  PubMed  Google Scholar 

  12. Nakagawa K, Serrador JM, LaRose SL, Sorond FA. Dynamic cerebral autoregulation after intracerebral hemorrhage: a case-control study. BMC Neurol. 2011;11:108. https://doi.org/10.1186/1471-2377-11-108.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ortega-Gutierrez S, Petersen N, Masurkar A, Reccius A, Huang A, Li M, Choi JH, Marshall RS. Reliability, asymmetry, and age influence on dynamic cerebral autoregulation measured by spontaneous fluctuations of blood pressure and cerebral blood flow velocities in healthy individuals. J Neuroimaging. 2014;24:379–86. https://doi.org/10.1111/jon.12019.

    Article  PubMed  Google Scholar 

  14. Otite F, Mink S, Tan CO, Puri A, Zamani AA, Mehregan A, Chou S, Orzell S, Purkayastha S, Du R, Sorond FA. Impaired cerebral autoregulation is associated with vasospasm and delayed cerebral ischemia in subarachnoid hemorrhage. Stroke. 2014;45:677–82. https://doi.org/10.1161/STROKEAHA.113.002630.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Petersen NH, Ortega-Gutierrez S, Reccius A, Masurkar A, Huang A, Marshall RS. Comparison of non-invasive and invasive arterial blood pressure measurement for assessment of dynamic cerebral autoregulation. Neurocrit Care. 2014;20:60–8. https://doi.org/10.1007/s12028-013-9898-y.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Petersen NH, Ortega-Gutierrez S, Reccius A, Masurkar A, Huang A, Marshall RS. Dynamic cerebral autoregulation is transiently impaired for one week after large-vessel acute ischemic stroke. Cerebrovasc Dis. 2015;39:144–50. https://doi.org/10.1159/000368595.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Radolovich DK, Aries MJ, Castellani G, Corona A, Lavinio A, Smielewski P, Pickard JD, Czosnyka M. Pulsatile intracranial pressure and cerebral autoregulation after traumatic brain injury. Neurocrit Care. 2011;15:379–86. https://doi.org/10.1007/s12028-011-9553-4.

    Article  CAS  PubMed  Google Scholar 

  18. Reinhard M, Rutsch S, Lambeck J, Wihler C, Czosnyka M, Weiller C, Hetzel A. Dynamic cerebral autoregulation associates with infarct size and outcome after ischemic stroke. Acta Neurol Scand. 2012;125:156–62. https://doi.org/10.1111/j.1600-0404.2011.01515.x.

    Article  CAS  PubMed  Google Scholar 

  19. Solenski NJ, Haley EC Jr, Kassell NF, Kongable G, Germanson T, Truskowski L, Torner JC. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. 1995;23:1007–17.

    Article  CAS  Google Scholar 

  20. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354:387–96. https://doi.org/10.1056/NEJMra052732.

    Article  CAS  PubMed  Google Scholar 

  21. Willie CK, Tzeng YC, Fisher JA, Ainslie PN. Integrative regulation of human brain blood flow. J Physiol. 2014;592:841–59. https://doi.org/10.1113/jphysiol.2013.268953.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

No funding was received for this research.

Conflict of Interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA

    S. Ortega-Gutierrez, E. A. Samaniego & B. Zheng-Lin

  2. Department of Critical Care, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile

    A. Reccius

  3. Department of Neurology, Columbia University, New York, NY, USA

    A. Huang, A. Masukar & R. S. Marshall

  4. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA

    N. H. Petersen

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  1. S. Ortega-Gutierrez
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  4. A. Huang
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Correspondence to S. Ortega-Gutierrez .

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Editors and Affiliations

  1. Department of Anethesiology, Loma Linda University Medical Center, Loma Linda, CA, USA

    Robert D. Martin

  2. Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, USA

    Warren Boling

  3. Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China

    Gang Chen

  4. Department of Anesthesiology and Physiology, Loma Linda University Medical Center, Loma Linda, CA, USA

    John H. Zhang

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Ortega-Gutierrez, S. et al. (2020). Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage. In: Martin, R., Boling, W., Chen, G., Zhang, J. (eds) Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 127. Springer, Cham. https://doi.org/10.1007/978-3-030-04615-6_22

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  • DOI: https://doi.org/10.1007/978-3-030-04615-6_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04614-9

  • Online ISBN: 978-3-030-04615-6

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