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Neurocritical Care
Published in: Neurocritical Care 2/2015

01-10-2015 | Original Article

Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Using Cerebral Blood Flow Velocities and Cerebral Autoregulation Assessment

Authors: Lionel Calviere, Nathalie Nasr, Catherine Arnaud, Marek Czosnyka, Alain Viguier, Bernard Tissot, Jean-Christophe Sol, Vincent Larrue

Published in: Neurocritical Care | Issue 2/2015

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Abstract

Background

The risk of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is associated with large cerebral artery vasospasm, but vasospasm is not a strong predictor for DCI. Assessment of cerebral autoregulation with transcranial Doppler (TCD) may improve the prediction of DCI. The aim of this prospective study was to assess the value of TCD-derived variables to be used alone or in combination for prediction of DCI.

Methods

We included consecutive patients with low-grade aneurysmal SAH within 4 days of aneurysm rupture. Cerebral autoregulation was evaluated using the moving correlation coefficient Mx calculated from spontaneous fluctuations of cerebral blood flow velocities and arterial blood pressure. Transcranial color-coded sonography was performed to assess large artery vasospasm.

Results

Thirty patients (19 women and 11 men; mean age ± SD 44.7 ± 12.1 years) were included. Twenty (66.7 %) patients had vasospasm. DCI occurred in six (20 %) patients after a median delay of 10 days (range 8–13 days). Cerebral autoregulation was impaired at baseline and at day 7 and then returned to normal at day 14. Neither cerebral autoregulation impairment nor large artery vasospasm alone was associated with DCI. In contrast, the combination of large artery vasospasm with worsening impairment of cerebral autoregulation from baseline to day 7 was significantly correlated to subsequent DCI (p = 0.007).

Conclusions

Early deterioration of cerebral autoregulation was strongly predictive of DCI in patients with large artery vasospasm after low-grade SAH. Our results suggest that consideration to both cerebral blood flow velocities and cerebral autoregulation may improve the prediction of DCI.
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Metadata
Title
Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Using Cerebral Blood Flow Velocities and Cerebral Autoregulation Assessment
Authors
Lionel Calviere
Nathalie Nasr
Catherine Arnaud
Marek Czosnyka
Alain Viguier
Bernard Tissot
Jean-Christophe Sol
Vincent Larrue
Publication date
01-10-2015
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2015
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0125-x

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