Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm

Nogueira, Raul G; Lev, Michael H.; Roccatagliata, Luca; Hirsch, Joshua A; González, R. Gilberto; Ogilvy, Christopher S.; Halpern, Elkan F.; Rordorf, Guy; Rabinov, James D.; Pryor, Johnny C.

doi:10.3174/ajnr.a1275

Cited by 42 publications

(22 citation statements)

References 22 publications

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“…23 Because patients with extensive infarction can have impaired autoregulation, the absence of a change in CBV may be because of either the persistence of this impairment or the decreased sensitivity to acute changes after surgery. 24 A late PCT study could confirm this hypothesis.…”

Section: May 2014supporting

confidence: 72%

Improved Hemodynamic Parameters in Middle Cerebral Artery Infarction After Decompressive Craniectomy

Amorim

Andrade

Gattás

et al. 2014

Stroke

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This was a single-center, prospective cohort study. The patients were consecutively enrolled at the emergency room of a tertiary hospital. The recruitment period was from January 2008 to September 2012, and the patients had a 6-month follow-up after the surgical procedure.Background and Purpose-Decompressive craniectomy (DC) reduces mortality and improves functional outcome in patients with malignant middle cerebral artery infarction. However, little is known regarding the impact of DC on cerebral hemodynamics. Therefore, our goal was to study the hemodynamic changes that may occur in patients with malignant middle cerebral artery infarction after DC and to assess their relationship with outcomes. Methods-Twenty-seven patients with malignant middle cerebral artery infarction who were treated with DC were studied.The perfusion CT hemodynamic parameters, mean transit time, cerebral blood flow, and cerebral blood volume were evaluated preoperatively and within the first 24 hours after DC. Results-There was a global trend toward improved cerebral hemodynamics after DC. Preoperative and postoperative absolute mean transit times were associated with mortality at 6 months, and the ratio of post-and preoperative cerebral blood flow was significantly higher in patients with favorable outcomes than those with unfavorable outcomes. Patients who underwent surgery 48 hours after stroke, those with midline brain shift >10 mm, and those who were >55 years showed no significant improvement in any perfusion CT parameters. Conclusions-DC improves cerebral hemodynamics in patients with malignant middle cerebral artery infarction, and the level of improvement is related to outcome. However, some patients did not seem to experience any additional hemodynamic benefit, suggesting that perfusion CT may play a role as a prognostic tool in patients undergoing DC after ischemic stroke. (Stroke. 2014;45:1375-1380.)

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Section: May 2014supporting

confidence: 72%

Improved Hemodynamic Parameters in Middle Cerebral Artery Infarction After Decompressive Craniectomy

Amorim

Andrade

Gattás

et al. 2014

Stroke

View full text Add to dashboard Cite

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“…38 Also there is evidence that CBV maps obtained with high-resolution imaging could add value to planning and performing a biopsy in patients with brain tumors. 39 Further investigations are necessary to confirm our preliminary results in this small group of patients.…”

Section: Discussionmentioning

confidence: 99%

Flat Detector CT in the Evaluation of Brain Parenchyma, Intracranial Vasculature, and Cerebral Blood Volume: A Pilot Study in Patients with Acute Symptoms of Cerebral Ischemia

Struffert¹,

Yu²,

Kloska³

et al. 2010

AJNR Am J Neuroradiol

121

125

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BACKGROUND AND PURPOSE:The viability of both brain parenchyma and vascular anatomy is important in estimating the risk and potential benefit of revascularization in patients with acute cerebral ischemia. We tested the hypothesis that when used in conjunction with IV contrast, FD-CT imaging would provide both anatomic and physiologic information that would correlate well with that obtained by using standard multisection CT techniques.

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“…63 In animal models of subarachnoid hemorrhage, prolongation of MTT was associated with vasospasm and early mortality. 64 CTP has also been used in humans to assess the therapeutic effect of both intra-arterial vasodilators 65 and intravascular stent placement, 66 with improvement in CBF and MTT after treatment. Areas of perfusion abnormality in the setting of vasospasm should be considered at-risk territories akin to penumbra, though the pathophysiology of these 2 entities is different.…”

Section: Vasospasmmentioning

confidence: 99%

Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls

Lui¹,

Tang²,

Allmendinger³

et al. 2010

AJNR Am J Neuroradiol

120

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SUMMARY: CTP has a growing role in evaluating stroke. It can be performed immediately following NCCT and has advantages of accessibility and speed. Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Still, CTP interpretation can be complex. We review normal and ischemic perfusion patterns followed by an illustrative series of technical/diagnostic challenges of CTP interpretation in the setting of acute stroke syndromes.ABBREVIATIONS: ACA ϭ anterior cerebral artery; AIF ϭ arterial input function; ASPECTS ϭ Alberta Stroke Program Early CT Score; CBF ϭ cerebral blood flow; CBV ϭ cerebral blood volume; CTA ϭ CT angiography; CTP ϭ CT perfusion; DWI ϭ diffusion-weighted imaging; ICA ϭ internal carotid artery; MCA ϭ middle cerebral artery; MTT ϭ mean transit time; NCCT ϭ noncontrast CT; PET ϭ positron-emission tomography; SPECT ϭ single-photon emission CT; TTP ϭ time to peak; VOF ϭ venous output function

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Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm

Abstract: BACKGROUND AND PURPOSE: Our aim was to determine the effects of intra-arterial (IA) nicardipine infusion on the cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH)-induced vasospasm by using first-pass quantitative cine CT perfusion (CTP).

Cited by 42 publications

References 22 publications

Improved Hemodynamic Parameters in Middle Cerebral Artery Infarction After Decompressive Craniectomy

Improved Hemodynamic Parameters in Middle Cerebral Artery Infarction After Decompressive Craniectomy

Flat Detector CT in the Evaluation of Brain Parenchyma, Intracranial Vasculature, and Cerebral Blood Volume: A Pilot Study in Patients with Acute Symptoms of Cerebral Ischemia

Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls

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