ADMISSION ANGIOGRAPHIC CEREBRAL CIRCULATION TIME MAY PREDICT SUBSEQUENT ANGIOGRAPHIC VASOSPASM AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Abstract OBJECTIVE Angiographic cerebral vasospasm occurs in approximately 70% of patients hospitalized after aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor outcome. In this study, we examined whether or not cerebral circulation time (CCT) measured with digital subtraction angi...

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Published in:Neurosurgery Vol. 61; no. 6; pp. 1152 - 1161
Main Authors: Udoetuk, Joshua D., Stiefel, Michael F., Hurst, Robert W., Weigele, John B., LeRoux, Peter D.
Format: Journal Article
Language:English
Published: United States Oxford University Press 01.12.2007
Wolters Kluwer Health, Inc
Subjects:
Adult
Aneurysms
Cerebral Angiography - methods
Cerebrovascular Circulation - physiology
Circulatory system
Female
Hemorrhage
Humans
Intracranial Aneurysm - complications
Male
Medical imaging
Medical prognosis
Middle Aged
Neurosurgery
Predictive Value of Tests
Retrospective Studies
Statistics, Nonparametric
Stroke
Subarachnoid Hemorrhage - complications
Time Factors
Tomography, X-Ray Computed
Vasospasm, Intracranial - diagnosis
Vasospasm, Intracranial - etiology
Vein & artery diseases
Cerebral circulation time
Microcirculation
Vasospasm
Subarachnoid hemorrhage
ISSN:0148-396X, 1524-4040, 1524-4040
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Summary:Abstract OBJECTIVE Angiographic cerebral vasospasm occurs in approximately 70% of patients hospitalized after aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor outcome. In this study, we examined whether or not cerebral circulation time (CCT) measured with digital subtraction angiography was associated with angiographic vasospasm. METHODS Patients who underwent cerebral angiography within 24 hours of SAH were analyzed. Contrast dye transit time from the arterial to the venous phase was measured to obtain CCT (supraclinoid internal carotid artery to parietal cortical veins) and microvascular CCT (cortical middle cerebral artery to parietal cortical veins). Patients with ruptured anterior circulation aneurysms and vasospasm on follow-up angiography (Group A) were compared with patients with SAH without vasospasm (Group B) and with normal control subjects (Group C). RESULTS There were 20 patients in Group A (mean age, 51 ± 13 yr), 17 patients in Group B (56 ± 12 yr), and 98 patients in Group C (52 ± 12 yr). CCT in patients in Group A (7.7 ± 1.9 s) was significantly longer than those in Groups B (6.6 ± 1.2 s; P = 0.005) and C (5.9 ± 1 s; P < 0.001). Microvascular CCT in patients in Group A (7.1 ± 1.8 s) was significantly longer than those in Groups B (6.1 ± 1.2 s; P = 0.003) and C (5.4 ± 0.9 s; P < 0.001). CONCLUSION Prolonged CCT, a measurement of increased small vessel resistance, can be identified within 24 hours after SAH and is associated with subsequent angiographic vasospasm. These results suggest that microcirculation changes may be involved in vasospasm.
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ISSN:0148-396X
1524-4040
1524-4040
DOI:10.1227/01.neu.0000306092.07647.6d