Abstract
Background: A certain correlation between unfavorable clinical outcome, incidence of vasospasm, and impaired pressure autoregulation in patients following aneurysmal subarachnoid hemorrhage (aSAH) has been suggested. However, determination of vasospasm is inaccurate and the measurement technique of cerebral vasoreactivity seems not to have been sufficiently validated. Therefore, a correlation of clinical outcome and the extent of angiographic VS was performed using an established autoregulation test.
Material and Methods: Proximal and global angiographic vasospasm (pVS, gVS) were determined in bilateral M1 segments. Dynamic tests of pressure autoregulation were performed 1 day before and after, and on the day of angiography using Aaslid’s thigh leg cuff test. Patient outcome was assessed using the Extended Glasgow Outcome Scale (GOSE).
Key Results: Complete datasets were available for 22 patients. Mean autoregulatory indices (ARI) around the day of angiography were 3.9 ± 2.3. Proximal mean reduction of vessel diameter was −23.3% ± 9.1%. Global vasospasm was not present in 10 hemispheres, mild in 15, moderate in 15, and severe in 4. Hemispheric ARI values and angiographic data showed a significant correlation (pVS −0.382, p = 0.015; gVS −0.477, p = 0.002). The degree of angiographic vasospasm and low ARI values correlated significantly with an unfavorable outcome (0.677, p = 0.001).
Conclusion: Incidence of angiographic vasospasm and impaired clinical outcome seems to be related to impaired pressure autoregulation following aSAH.
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References
Aaslid R (2006) Cerebral autoregulation and vasomotor reactivity. In: Baumgartner RW (ed) Handbook on neurovascular ultrasound, vol 21. Karger, Basel, pp 216–228
Aaslid R, Lindegaard KF, Sorteberg W, Nornes H (1989) Cerebral autoregulation dynamics in humans. Stroke 20:45–52
Barth M, Woitzik J, Weiss C, Muench E, Diepers M, Schmiedek P, Kasuya H, Vajkoczy P (2010) Correlation of clinical outcome with pressure-, oxygen-, and flow-related indices of cerebrovascular reactivity in patients following aneurysmal SAH. Neurocrit Care 12:234–243
Carrera E, Schmidt JM, Oddo M, Fernandez L, Claassen J, Seder D, Lee K, Badjatia N, Connolly ES Jr, Mayer SA (2009) Transcranial Doppler for predicting delayed cerebral ischemia after subarachnoid hemorrhage. Neurosurgery 65:316–323, discussion 323–314
Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD (1997) Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery 41:11–17, discussion 17–19
Hlatky R, Furuya Y, Valadka AB, Gonzalez J, Chacko A, Mizutani Y, Contant CF, Robertson CS (2002) Dynamic autoregulatory response after severe head injury. J Neurosurg 97:1054–1061
Jaeger M, Schuhmann MU, Soehle M, Meixensberger J (2006) Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity. Crit Care Med 34:1783–1788
Jaeger M, Schuhmann MU, Soehle M, Nagel C, Meixensberger J (2007) Continuous monitoring of cerebrovascular autoregulation after subarachnoid hemorrhage by brain tissue oxygen pressure reactivity and its relation to delayed cerebral infarction. Stroke 38:981–986
Lee JY, Lee MS, Whang K, Lee JM, Kim SH, Lee SS (2006) Accuracy of transcranial Doppler sonography for predicting cerebral infarction in aneurysmal subarachnoid hemorrhage. J Clin Ultrasound 34:380–384
Macdonald RL, Kassell NF, Mayer S, Ruefenacht D, Schmiedek P, Weidauer S, Frey A, Roux S, Pasqualin A (2008) Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke 39:3015–3021
Raabe A, Beck J, Berkefeld J, Deinsberger W, Meixensberger J, Schmiedek P, Seifert V, Steinmetz H, Unterberg A, Vajkoczy P, Werner C (2005) Recommendations for the management of patients with aneurysmal subarachnoid hemorrhage. Zentralbl Neurochir 66:79–91
Soehle M, Czosnyka M, Pickard JD, Kirkpatrick PJ (2004) Continuous assessment of cerebral autoregulation in subarachnoid hemorrhage. Anesth Analg 98:1133–1139, table of contents
Zweifel C, Castellani G, Czosnyka M, Carrera E, Brady KM, Kirkpatrick PJ, Pickard JD, Smielewski P (2010) Continuous assessment of cerebral autoregulation with near-infrared spectroscopy in adults after subarachnoid hemorrhage. Stroke 41:1963–1968
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Barth, M., Moratin, B., Dostal, M., Kalenka, A., Scharf, J., Schmieder, K. (2012). Correlation of Clinical Outcome and Angiographic Vasospasm with the Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage. In: Schuhmann, M., Czosnyka, M. (eds) Intracranial Pressure and Brain Monitoring XIV. Acta Neurochirurgica Supplementum, vol 114. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0956-4_29
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DOI: https://doi.org/10.1007/978-3-7091-0956-4_29
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