Transcranial Doppler velocity and associations with delayed cerebral ischemia in aneurysmal subarachnoid Hemorrhage

Chang, Jason J.; Triano, Matthew; Corbin, Maite J; Desale, Sameer; Liu, Ai‐Hsi; Felbaum, Daniel R.; Jeffrey, C.; Armonda, Rocco A.; Aulisi, Edward F.

doi:10.1016/j.jns.2020.116934

Cited by 19 publications

(14 citation statements)

References 20 publications

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“…During our investigations, we found that the serum level of Il-4 measured on Day 5–7 was significantly higher in TCD-positive patients than in TCD-negative ones. TCD measurements of cerebral blood flow velocity are commonly used after aSAH to screen for vasospasm; however, their association with cerebral infarction is not well characterized and is still partially controversial [ 36 , 37 , 38 ]. In a very recent study, an early, mild, TCD-based vasospasm severity threshold had a high negative predictive value for DCI [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Biomarker Associations in Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

Spantler

Molnár

Simon

et al. 2022

IJMS

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The prognosis for patients with aneurysmal subarachnoid hemorrhage (aSAH) is heavily influenced by the development of delayed cerebral ischemia (DCI), but the adequate and effective therapy of DCI to this day has not been resolved. Multiplex serum biomarker studies may help to understand the pathophysiological processes underlying DCI. Samples were collected from patients with aSAH at two time points: (1) 24 h (Day 1) and (2) 5–7 days after ictus. Serum concentrations of eotaxin, FGF-2, FLT-3L, CX3CL1, Il-1b, IL-4, IP-10, MCP3, and MIP-1b were determined using a customized MILLIPLEX Human Cytokine/Chemokine/Growth Factor Panel A multiplex assay. The functional outcome was defined by the modified Rankin scale (favorable: 0–2, unfavorable: 3–6) measured on the 30th day after aSAH. One-hundred and twelve patients with aSAH were included in this study. The median level of CX3CL1 and MCP-3 measured on Days 5–7 were significantly higher in patients with DCI compared with those without DCI (CX3CL1: with DCI: 110.5 pg/mL, IQR: 82–201 vs. without DCI: 82.6, 58–119, p = 0.036; and MCP-3: with DCI: 22 pg/mL (0–32) vs. without DCI: 0 (0–11), p < 0.001). IP-10, MCP-3, and MIP-1b also showed significant associations with the functional outcome after aSAH. MCP-3 and CX3CL1 may play a role in the pathophysiology of DCI.

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Section: Discussionmentioning

confidence: 99%

Biomarker Associations in Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

Spantler

Molnár

Simon

et al. 2022

IJMS

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“…Arterial vasospasm (angiographic evidence and/or sonographic suspicion) is considered the most common cause of ischemia and clinical deterioration; specially delayed cerebral ischemia (DCI) (30%), although pathophysiology leading remains unclear [80], sometimes is reversible but may also progress to cerebral infarction [81]. The excellent sensitivity (90%) and high negative predictive value (92%) makes TCD/TCCS an ideal screening tool for detecting vasospasm in SAH [31].…”

Section: Aneurysmal Subarachnoid Hemorrhage (Sah)mentioning

confidence: 99%

“…The ultrasound machine will then generate a series of values, the most important of which is the MFV (TAV: time-average velocity or TAMAX: time-average maximum velocity). Progressive or persistent increase in blood flow velocity in a given vessel suggests focal vasospasm [23,54] and may be associated with DCI [80].…”

Section: Aneurysmal Subarachnoid Hemorrhage (Sah)mentioning

confidence: 99%

Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

Rodríguez

Geeraerts

2021

Neurosonology in Critical Care

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The basic principle of neurosurgical patient management is to ensure adequate brain tissue perfusion, maintaining a sufficient blood flow to supply energy and oxygen to the brain parenchyma. 2. If neuroworsening occurs after a neurosurgical procedure, prompt recognition is essential because it may be the first indication of potential complications. 3. In many clinical scenarios during neurosurgical postoperative period, TCD/ TCCS may have a transcendent role in diminished gap between neurological clinical examination and other investigations that may be invasive or require patient transport outside of the ICU. 4. Midline shift (MLS) monitoring is important for preventing neurological worsening and assess early neurosurgical intervention. Keep in mind that any amount of midline shift is considered abnormal. 5. Measurement of volume of Intracerebral Hematoma (ICH) is a very useful monitoring tool in the daily bedside following, and thus contribute to therapeutic decisions in real time interpreting the clinical trends. 6. The most used approach, to diagnose hydrocephalus by TCCS, is the measurement of the diameter of the third ventricle through the transtemporal window. 7. It is critical to interpret and integrate hemodynamic qualitative and quantitative trends (not only the absolute value) of the Spectral Doppler wave (blood flow velocity patterns) with the clinical context of the patient.

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“…Each year the United States has 30,000 cases of subarachnoid hemorrhage (SAH), which is consistent with the global incidence rate and represents a significant cause of stroke-related death and disability 1 . Vasospasm is the narrowing of the cerebral arteries and is a common complication of SAH that can lead to delayed cerebral ischemia (DCI), with DCI leading to poor patient outcomes and is associated with morbidity and mortality following SAH 2 , 3 . Digital subtraction angiography (DSA), and increasingly computer tomography angiography (CTA) are considered the gold standard for determination of cerebral vasospasm as it allows for clear visualization of vasculature 4 .…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of a novel robotic transcranial doppler system in subarachnoid hemorrhage

Clare

Stein

Damodara

et al. 2022

Sci Rep

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Delayed cerebral ischemia (DCI) secondary to vasospasm is a determinate of outcomes following non-traumatic subarachnoid hemorrhage (SAH). SAH patients are monitored using transcranial doppler (TCD) to measure cerebral blood flow velocities (CBFv). However, the accuracy and precision of manually acquired TCD can be operator dependent. The NovaGuide robotic TCD system attempts to standardize acquisition. This investigation evaluated the safety and efficacy of the NovaGuide system in SAH patients in a Neuro ICU. We retrospectively identified 48 NovaGuide scans conducted on SAH patients. Mean and maximum middle cerebral artery (MCA) CBFv were obtained from the NovaGuide and the level of agreement between CBFv and computed tomography angiography (CTA) for vasospasm was determined. Safety of NovaGuide acquisition of CBFv was evaluated based on number of complications with central venous lines (CVL) and external ventricular drains (EVD). There was significant agreement between the NovaGuide and CTA (Cohen’s Kappa = 0.74) when maximum MCA CBFv ≥ 120 cm/s was the threshold for vasospasm. 27/48 scans were carried out with CVLs and EVDs present without negative outcomes. The lack of adverse events associated with EVDs/CVLs and the strong congruence between maximal MCA CBFv and CTA illustrates the diagnostic utility of the NovaGuide.

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Transcranial Doppler velocity and associations with delayed cerebral ischemia in aneurysmal subarachnoid Hemorrhage

Cited by 19 publications

References 20 publications

Biomarker Associations in Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

Biomarker Associations in Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

Safety and efficacy of a novel robotic transcranial doppler system in subarachnoid hemorrhage

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