Angiographic cerebral vasospasm and delayed ischemic deficit on anterior part of the circle of Willis. Usefulness of transcranial Doppler.
OBJECTIVE
After subarachnoid hemorrhage (SAH), cerebral vasospasm (VS) may be revealed by cerebral angiography, during follow-up clinical examination with the occurrence of delayed ischemic deficit (DID). Moreover, transcranial Doppler (TCD) could be useful in determining the level of the velocimetric threshold. The aims of the study were, on a prospectively collected series of 460 patients, to assess angiographic VS incidence, to determine possible risk factors, and to evaluate diagnostic sensitivity and specificity of TCD.


METHODS
A total of 460 patients consecutively operated on for an aneurysm located on the anterior portion of the circle of Willis (mean age 47.2 +/- 14 years, sex ratio F/M=1.18) were included in the study. Preventive treatment against VS was administered in all patients. On the 10(th) day, we performed the following routine examinations: cerebral angiography, CT scan and TCD.


RESULTS
Angiographic VS occurred in 38.5% of the patients, and the single risk factor was delayed admission (p=0.02, Mann-Whitney test). DID occurred in 15.6% and was complicated by cerebral infarct in 4.7%. The risk factors were admission date (p=0.001, Mann-Whitney test) and severity of arterial narrowing (significant tendency). Diagnostic sensitivity of TCD decreased from 83.6% for MCA aneurysms, to 66.6% for ICA aneurysms and 40.6% for AcoA aneurysms. Diagnosis specificity remained between 88.6% and 97.6% for the 3 locations.


CONCLUSIONS
The unique risk factor for angiographic VS and DID was the admission date. TCD demonstrated high specificity but its sensitivity was too low for the aneurysms located far from the middle cerebral artery bifurcation.
Proust
F
F
Service de Neurochirurgie, Hôpital Charles-Nicolle, CHU Rouen, boulevard Gambetta, 76031 Rouen Cedex. Francois.Proust@chu-rouen.fr
Debono
B
B
Gérardin
E
E
Hannequin
D
D
Derrey
S
S
Langlois
O
O
Weber
J
J
Fréger
P
P
D000418:Albumins / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002533:Cerebral Angiography / Q000379:methods*; D002941:Circle of Willis / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000209:etiology
D000418:Albumins; D000927:Anticonvulsants; D002121:Calcium Channel Blockers