title: Angiographic assessment of cerebral circulation time for outcome prediction in patients with subarachnoid hemorrhage.
abstract: BACKGROUND
  In the acute stage following subarachnoid hemorrhage (SAH), prolonged cerebral circulation time reflects increased intracranial pressure (ICP), which can lead to irreversible brain damage. We evaluated the ability of cerebral circulation time to predict outcome in SAH patients.
  
  
  METHODS
  We prospectively studied 40 consecutive patients treated for SAH according to standard intensive care guidelines. Lateral views in preoperative carotid digital subtraction arteriograms (DSA) were used to determine arteriovenous transit time (AVTT), defined as interval from initial opacification of the intracranial internal carotid artery to that of the Rolandic vein. We then analyzed relationship of AVTT to other prognostic parameters and outcome.
  
  
  RESULTS
  AVTT depended on initial Glasgow Coma Scale score (GCS), ranging from 3.4 to 8.0 seconds (mean: 5.4) when initial GCS was 13 to 15; from 4.5 to 8.7 seconds (mean: 6.4) when initial GCS was 7 to 12; and from 5.8 to 15.0 seconds (mean: 9.1 seconds, excluding angiograms with nonfilling) when initial GCS was 3 to 6. AVTT correlated significantly with prognosis, longer AVTT predicting poorer outcome. No patient with an AVTT above 12 seconds recovered to a functioning state.
  
  
  CONCLUSIONS
  AVTT obtained from routinely performed acute-phase DSA in SAH patients reflects ICP and functional prognosis, representing a cost-effective, practical, and reliable outcome predictor.
authors.affiliation: Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yoshimoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sanada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery; D015901:Angiography, Digital Subtraction; D001776:Blood Circulation Time; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000503:physiopathology*