Hyperacute measurement of brain-tissue oxygen, carbon dioxide, pH, and intracranial pressure before, during, and after cerebral angiography in patients with aneurysmatic subarachnoid hemorrhage in poor condition.
BACKGROUND
The objective of this study was to examine early changes of intracranial pressure (ICP) and brain oxygenation before, during, and after cerebral angiography in patients with poor-grade subarachnoid hemorrhage (SAH).


METHODS
Fourteen patients with poor-grade SAH without intracerebral hematoma were studied. A significant change in monitored variables (arterial gases, ICP, brain-tissue oxygen pressure [Ptio(2)], brain-tissue carbon dioxide pressure, and pH) was defined as a register deviation of more than 20% compared with the baseline. Critical Ptio(2) values (<15 mm Hg) or significant Ptio(2) decreases were considered to be impaired brain oxygenation. These data were correlated with the angiography findings and the presence of massive brain edema and hypodense areas in follow-up computed tomography (CT) scan controls.


RESULTS
Neurotrend data were unavailable in 4 patients because of calibration failure. Impaired brain oxygenation during angiography was observed in 5 patients. Initial critical Ptio(2) values were found in 1 patient. Four patients developed a linear Ptio(2) and pH decrease after the angio-catheter canalized the examined vessels in the neck. Statistically significant correlation was found between brain pH and Ptio(2) changes in these patients (P < .001, Spearman rho). Arterial gases, ICP, and cerebral perfusion pressure did not show significant alterations at this time. Significant correlations existed between severe intracranial angiographic arterial caliber reduction and impaired Ptio(2) values (P < .01). Patients with impaired Ptio(2) values frequently showed lesions in CT scan controls (P < .05).


CONCLUSIONS
This study documented several fluctuations in the brain oxygenation of patients with poor-grade SAH during angiography. Patients with severe intracranial angiographic arterial caliber reduction at this time have an increased risk for impaired brain oxygenation.
Carvi y Nievas
Mario
M
Department of Neurosurgery, Städtische Kliniken, J.W. Goethe Universität FFM, 65929 Gotenstrasse 6-8, 65929 Frankfurt am Main Höchst, Germany. mcnievas@t-online.de
Toktamis
Selim
S
Höllerhage
Hans-Georg
HG
Haas
Eberhard
E
D000328:Adult; D001929:Brain Edema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D020520:Brain Infarction / Q000175:diagnosis / Q000503:physiopathology; D002245:Carbon Dioxide / Q000032:analysis* / Q000378:metabolism; D015984:Causality; D002533:Cerebral Angiography / Q000592:standards; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis* / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D013223:Statistics as Topic; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
D002245:Carbon Dioxide; D010100:Oxygen