Transcranial Doppler Versus CT-Angiography for Detection of Cerebral Vasospasm in Relation to Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Prospective Single-Center Cohort Study: The Transcranial Doppler and CT-angiography...

Overview

Journal Crit Care Explor

Specialty Critical Care

Date 2020 Mar 14

PMID 32166226

Citations 14

Authors

J Joep van der Harst

Gert-Jan R Luijckx

Jan Willem J Elting

Reinoud P H Bokkers

Walter M van den Bergh

Omid S Eshghi

Jan D M Metzemaekers

Rob J M Groen

Aryan Mazuri

J Marc C van Dijk

Maarten Uyttenboogaart

Affiliations

Soon will be listed here.

Abstract

Design: Prospective diagnostic accuracy study.

Settings: Neurocritical care unit and neurosurgical ward at a tertiary academic medical center.

Patients: Between 2013 and 2016, 59 consenting patients were included.

Intervention: Patients undergo both transcranial Doppler and CT angiography for detection of cerebral vasospasm on days 5 and 10 after aneurysmal subarachnoid hemorrhage. Delayed cerebral ischemia was defined as secondary neurologic deterioration, not explained otherwise. Unfavorable outcome was defined modified Rankin Scale > 2 at 6 months.

Measurements And Main Results: On transcranial Doppler, cerebral vasospasm was observed in 26 patients (45%). On CT angiography, vasospasm was observed in 54 patients (95%). The agreement between transcranial Doppler and CT angiography was 0.47. Delayed cerebral ischemia occurred in 16 patients (27%); unfavorable outcome in 12 patients (20%). Transcranial Doppler predicted delayed cerebral ischemia with a sensitivity of 0.44 (day 5) and 0.50 (day 10), with a specificity of 0.67 (day 5) and 0.57 (day 10). CT angiography predicted delayed cerebral ischemia with a sensitivity of 0.81 (day 5 and 10) and with a specificity of 0.070 (day 5) and 0.00 (day 10). The highest accuracy for predicting unfavorable outcome was on day 5 (0.61 for transcranial Doppler vs 0.27 for CT angiography).

Conclusion: The diagnostic accuracy of both CT angiography and transcranial Doppler for detection of cerebral vasospasm as well as prediction of delayed cerebral ischemia and functional outcome is limited. The agreement between CT angiography and transcranial Doppler is low.

Citing Articles

Rationale and Design for the BLOCK-SAH Study (Pterygopalatine Fossa Block as an Opioid-Sparing Treatment for Acute Headache in Aneurysmal Subarachnoid Hemorrhage): A Phase II, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Clinical....

Busl K, Smith C, Troxel A, Fava M, Illenberger N, Pop R Neurocrit Care. 2024; 42(1):290-300.

PMID: 39138719 PMC: 11810580. DOI: 10.1007/s12028-024-02078-z.

Transcranial Doppler in the Detection of Cerebral Vasospasm After Subarachnoid Hemorrhage.

Hakim M, Kawnayn G, Hassan M, Uddin M, Hasan M, Huq M Cureus. 2024; 16(6):e61569.

PMID: 38962631 PMC: 11221191. DOI: 10.7759/cureus.61569.

Diagnostic value of transcranial doppler to predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : To predict delayed cerebral ischemia.

van der Harst J, Elting J, Hijlkema J, Veeger N, van Donkelaar C, van Dijk J Acta Neurochir (Wien). 2024; 166(1):278.

PMID: 38949680 PMC: 11217085. DOI: 10.1007/s00701-024-06164-1.

Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist.

Robba C, Busl K, Claassen J, Diringer M, Helbok R, Park S Intensive Care Med. 2024; 50(5):646-664.

PMID: 38598130 PMC: 11078858. DOI: 10.1007/s00134-024-07387-7.

Intracranial dynamics biomarkers at traumatic cerebral vasospasm.

Trofimov A, Trofimova S, Agarkova D, Trofimova K, Semyachkina-Glushkovskaya O, Atochin D Brain Spine. 2024; 4:102727.

PMID: 38178989 PMC: 10765010. DOI: 10.1016/j.bas.2023.102727.

References

Wardlaw J, Offin R, Teasdale G, Teasdale E . Is routine transcranial Doppler ultrasound monitoring useful in the management of subarachnoid hemorrhage?. J Neurosurg. 1998; 88(2):272-6. DOI: 10.3171/jns.1998.88.2.0272. View

Dankbaar J, de Rooij N, Velthuis B, Frijns C, Rinkel G, van der Schaaf I . Diagnosing delayed cerebral ischemia with different CT modalities in patients with subarachnoid hemorrhage with clinical deterioration. Stroke. 2009; 40(11):3493-8. DOI: 10.1161/STROKEAHA.109.559013. View

Anderson G, Ashforth R, Steinke D, Findlay J . CT angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2000; 21(6):1011-5. PMC: 7973879. View

Kaufmann T, Huston 3rd J, Mandrekar J, Schleck C, Thielen K, Kallmes D . Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology. 2007; 243(3):812-9. DOI: 10.1148/radiol.2433060536. View

Vergouwen M . Vasospasm versus delayed cerebral ischemia as an outcome event in clinical trials and observational studies. Neurocrit Care. 2011; 15(2):308-11. DOI: 10.1007/s12028-011-9586-8. View

Hop J, Rinkel G, Algra A, van Gijn J . Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997; 28(3):660-4. DOI: 10.1161/01.str.28.3.660. View

Banks J, Marotta C . Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007; 38(3):1091-6. DOI: 10.1161/01.STR.0000258355.23810.c6. View

de Oliveira Manoel A, Jaja B, Germans M, Yan H, Qian W, Kouzmina E . The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Stroke. 2015; 46(7):1826-31. DOI: 10.1161/STROKEAHA.115.008728. View

Binaghi S, Colleoni M, Maeder P, Uske A, Regli L, Dehdashti A . CT angiography and perfusion CT in cerebral vasospasm after subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2007; 28(4):750-8. PMC: 7977351. View

10.

Ferguson S, Rosen D, Bardo D, Loch Macdonald R . Arterial diameters on catheter and computed tomographic angiography. World Neurosurg. 2010; 73(3):165-73. DOI: 10.1016/j.surneu.2008.12.017. View

11.

Aralasmak A, Akyuz M, Ozkaynak C, Sindel T, Tuncer R . CT angiography and perfusion imaging in patients with subarachnoid hemorrhage: correlation of vasospasm to perfusion abnormality. Neuroradiology. 2008; 51(2):85-93. DOI: 10.1007/s00234-008-0466-7. View

12.

Frontera J, Fernandez A, Schmidt J, Claassen J, Wartenberg K, Badjatia N . Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?. Stroke. 2009; 40(6):1963-8. DOI: 10.1161/STROKEAHA.108.544700. View

13.

Frontera J, Claassen J, Schmidt J, Wartenberg K, Temes R, Connolly Jr E . Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006; 59(1):21-7. DOI: 10.1227/01.neu.0000243277.86222.6c. View

14.

Suhardja A . Mechanisms of disease: roles of nitric oxide and endothelin-1 in delayed cerebral vasospasm produced by aneurysmal subarachnoid hemorrhage. Nat Clin Pract Cardiovasc Med. 2005; 1(2):110-6. DOI: 10.1038/ncpcardio0046. View

15.

Naqvi J, Yap K, Ahmad G, Ghosh J . Transcranial Doppler ultrasound: a review of the physical principles and major applications in critical care. Int J Vasc Med. 2014; 2013:629378. PMC: 3876587. DOI: 10.1155/2013/629378. View

16.

Connolly Jr E, Rabinstein A, Carhuapoma J, Derdeyn C, Dion J, Higashida R . Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012; 43(6):1711-37. DOI: 10.1161/STR.0b013e3182587839. View

17.

van Gijn J, Kerr R, Rinkel G . Subarachnoid haemorrhage. Lancet. 2007; 369(9558):306-18. DOI: 10.1016/S0140-6736(07)60153-6. View

18.

Naval N, Thomas C, Urrutia V . Relative changes in flow velocities in vasospasm after subarachnoid hemorrhage: a transcranial Doppler study. Neurocrit Care. 2005; 2(2):133-40. DOI: 10.1385/NCC:2:2:133. View

19.

Willinsky R, Taylor S, Terbrugge K, Farb R, Tomlinson G, Montanera W . Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology. 2003; 227(2):522-8. DOI: 10.1148/radiol.2272012071. View

20.

Kirsch J, Mathur M, Johnson M, Gowthaman G, Scoutt L . Advances in transcranial Doppler US: imaging ahead. Radiographics. 2013; 33(1):E1-E14. DOI: 10.1148/rg.331125071. View