Vasospasm after SAH due to aneurysm rupture of the anterior circle of Willis: value of TCD monitoring.
OBJECTIVE
The aim of this study was to verify the presence of angiographic vasospasm in patients with transcranial Doppler (TCD) of high velocities after subarachnoid hemorrhage (SAH).


METHODS
Seven hundred and eighty-six cases admitted within 48 hours after SAH due to the rupture of anterior circulation aneurysm, were prospectively studied with TCD. In cases of TCD velocities higher than 120 cm/s (TCD vasospasm), the patient underwent a control angiography. Hunt-Hess and Fisher's grade on admission CT and location of the aneurysm were related to occurrence of TCD vasospasm. The increase in TCD velocities within 24 hours was calculated and related to the presence of cerebral ischemia on discharge CT, considering three groups of patients: Group A with an increase in velocities higher than 60%, Group B with an increase in velocities between 30 and 60%, and Group C with an increase in velocities lower than 30%.


RESULTS
TCD vasospasm was observed in 216 patients (27%). In 97% of patients with TCD vasospasm on middle cerebral artery (MCA) and in 71% with TCD vasospasm on anterior cerebral artery (ACA), control angiography confirmed the vasospasm, with a significant lower diagnostic TCD predictivity of ACA spasm (chi2=28.204, p=0.000). The overall positive predictive value of TCD was 89%. There was no significant correlation of TCD vasospasm with clinical status on admission and location of the aneurysm, but a significant correlation between occurrence of TCD vasospasm and Fisher's grade (chi2=15.470, p=0.002) and between the increase rate in TCD velocities and cerebral ischemia (chi2=56.564, p=0.000).


CONCLUSIONS
Our study shows a good correlation between TCD and angiography to detect vasospasm on MCA, but the correlation is low for ACA. TCD alone cannot discriminate different hemodynamic pathways after SAH.
Fontanella
Marcomaria
M
Division of Neurosurgery, Department of Neuroscience, University of Torino, Torino, Italy. marco.fontanella@tin.it
Valfrè
Walter
W
Benech
Franco
F
Carlino
Christian
C
Garbossa
Diego
D
Ferrio
MariaFederica
M
Perez
Rosa
R
Berardino
Maurizio
M
Bradac
GianniBoris
G
Ducati
Alessandro
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications*; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D002941:Circle of Willis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000209:etiology*