title: Cerebral vasospasm affects arterial critical closing pressure.
abstract: The effect of cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (SAH) on critical closing pressure (CrCP) has not been fully delineated. Using cerebral impedance methodology, we sought to assess the behavior of CrCP during CVS. As CrCP expresses the sum of intracranial pressure (ICP) and vascular wall tension, we also explored its role in reflecting changes in vascular tone occurring in small vessels distal to spasm. This retrospective analysis was performed using recordings from 52 patients, diagnosed with CVS through transcranial Doppler measurements. Critical closing pressure was calculated noninvasively using arterial blood pressure and blood flow velocity. Outcome was assessed at both discharge and 3 months after ictus with the Glasgow Outcome Scale. The onset of CVS caused significant decreases in CrCP (P=0.025), without any observed significant changes in ICP (P=0.134). Vasospasm induced asymmetry, with CrCP ipsilateral to CVS becoming significantly lower than contralateral (P=0.025). Unfavorable outcomes were associated with a significantly lower CrCP after the onset of CVS (discharge: P=0.014; 3 months after SAH: P=0.020). Critical closing pressure is reduced in the presence of CVS in both temporal and spatial assessments. As ICP remained unchanged during CVS, reduced CrCP most probably reflects a lower wall tension in dilated small vessels distal to spasm.
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Georgios V
authors.initials: GV
authors.lastname: Varsos
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Karol P
authors.initials: KP
authors.lastname: Budohoski
authors.affiliation: 1] Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK [2] Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Angelos G
authors.initials: AG
authors.lastname: Kolias
authors.affiliation: 1] Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK [2] Service de Neurologie Vasculaire, Hôpital Purpan, Toulouse, INSERM U1048-Team 11 (I2MC-Toulouse), Université de Toulouse III, Toulouse, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Nasr
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Donnelly
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Xiuyun
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Brain and Cognitive Engineering, Korea University Anam-dong, Sungbuk-gu, Seoul, Korea.
authors.forename: Dong-Joo
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hutchinson
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kirkpatrick
authors.affiliation: Department of Neurosurgery, Red Cross Hospital, Athens, Greece.
authors.forename: Vassilis G
authors.initials: VG
authors.lastname: Varsos
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Smielewski
mesh_terms: D000328:Adult; D001794:Blood Pressure; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000503:physiopathology*