Comparison of Transcranial Doppler Investigation of Aneurysmal Vasospasm with Digital Subtraction Angiographic and Clinical Findings

Comparison of Transcranial Doppler Investigation of Aneurysmal Vasospasm with Digital Subtraction... AbstractOBJECTIVE:Transcranial Doppler (TCD) findings for evaluation of the severity of vasospasm (VSP) in patients with ruptured aneurysmal subarachnoid hemorrhage are controversial. To clarify these TCD findings, intra-arterial digital subtraction angiography was used to simultaneously investigate the angiographic features of cerebral vessels and the cerebral circulation time (CCT).METHODS:Fifty patients with ruptured aneurysms, for whom computed tomographic scans indicated Fisher Grade III subarachnoid hemorrhage, were investigated. Aneurysmal neck clipping was performed in the acute stage. The mean flow velocity (MFV) at the M1 segment was measured using TCD ultrasonography. Intra-arterial digital subtraction angiography was used to simultaneously investigate angiographic features and CCTs on Days 7 to 13. The CCT was defined as the time difference between the two peaks in optical density curves recorded at the carotid artery (C3-C4 portion) and the ascending vein, after contrast material injection. Angiographic VSP was categorized using a modification of the Fisher classification.RESULTS:Angiograms for 9, 25, and 16 patients showed no, slight to moderate, and severe VSP, respectively. The MFVs of the patients with no, slight to moderate, and severe VSP were 70, 115, and 116 cm/s, respectively. No significant difference among the three groups could be observed. The mean CCTs of the patients with no, slight to moderate, and severe VSP were 4.1, 4.6, and 6.5 seconds, respectively. The CCTs of the patients with severe VSP differed significantly from those of the patients with no or slight to moderate VSP. The patients with severe VSP were divided into two groups. One group included eight patients with severe VSP at proximal sites (the internal carotid artery to the M1 segment), and the other included eight patients with severe VSP extending to the M2 segment and more peripheral sites. The mean CCT of the former group (5.3 s) was significantly different from that of the latter (7.5 s), and the MFV of the former group (128 cm/s) was significantly higher than that of the latter (81 cm/s). The clinical outcomes for the latter patients were more serious than those for the former patients.CONCLUSION:This study suggests that the MFV at the M1 segment is inadequate for estimation of the severity of VSP extending to vessels more peripheral than the M1 segment. Furthermore, severe VSP extending to more Peripheral sites can produce more serious ischemic insults, compared with that localized to basal vessels. Patients with negative TCD results and clinical features suggesting the development of VSP should undergo quantitative investigation of cerebral circulatory parameters, such as the CCT, using intra-arterial digital subtraction Angiography. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Comparison of Transcranial Doppler Investigation of Aneurysmal Vasospasm with Digital Subtraction Angiographic and Clinical Findings

Comparison of Transcranial Doppler Investigation of Aneurysmal Vasospasm with Digital Subtraction Angiographic and Clinical Findings

Comparison of Transcranial Doppler Investigation of Aneurysmal Vasospasm with Digital Subtraction Angiographic and Clinical Findings Yoshikazu Okada, M.D., Takeshi Shima, M.D., Masahiro Nishida, M.D., Kanji Yamane, M.D., Takashi Hatayama, M.D., Chie Yamanaka, M.D., Akira Yoshida, M.D. Department of Neurosurgery (YO), Shimane Medical University, Izumo, Japan, and Department of Neurosurgery and Intensive Care Medicine (TS, MN, KY, TH, CY, AY), Chugoku Rousai Hospital, Kure, Japan OBJECTIVE: Transcranial Doppler (TCD) findings for evaluation of the severity of vasospasm (VSP) in patients with ruptured aneurysmal subarachnoid hemorrhage are controversial. To clarify these TCD findings, intra-arterial digital subtraction angiography was used to simultaneously investigate the angiographic features of cerebral vessels and the cerebral circulation time (CCT). METHODS: Fifty patients with ruptured aneurysms, for whom computed tomographic scans indicated Fisher Grade III subarachnoid hemorrhage, were investigated. Aneurysmal neck clipping was performed in the acute stage. The mean flow velocity (M FV) at the M1 segment was measured using TCD ultrasonography. Intra-arterial digital subtraction angiography was used to simultaneously investigate angiographic features and CCTs on Days 7 to 13. The CCT was defined as the time difference between the two peaks in optical density curves recorded at the carotid artery (C3-C4 portion) and the ascending vein, after contrast material injection. Angiographic VSP was categorized using a modification of the Fisher classification. RESULTS: Angiograms for 9, 25, and 16 patients showed no, slight to moderate, and severe VSP, respectively. The MFVs of the patients with no, slight to moderate, and severe VSP were 70, 115, and 116 cm/s, respectively. No significant difference among the three groups could be observed. The mean CCTs of the patients with no, slight to moderate, and severe VSP were 4.1, 4.6, and 6.5 seconds, respectively. The CCTs...
Loading next page...
 
/lp/ou_press/comparison-of-transcranial-doppler-investigation-of-aneurysmal-tC94ZQ8YOY
Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199909000-00005
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:Transcranial Doppler (TCD) findings for evaluation of the severity of vasospasm (VSP) in patients with ruptured aneurysmal subarachnoid hemorrhage are controversial. To clarify these TCD findings, intra-arterial digital subtraction angiography was used to simultaneously investigate the angiographic features of cerebral vessels and the cerebral circulation time (CCT).METHODS:Fifty patients with ruptured aneurysms, for whom computed tomographic scans indicated Fisher Grade III subarachnoid hemorrhage, were investigated. Aneurysmal neck clipping was performed in the acute stage. The mean flow velocity (MFV) at the M1 segment was measured using TCD ultrasonography. Intra-arterial digital subtraction angiography was used to simultaneously investigate angiographic features and CCTs on Days 7 to 13. The CCT was defined as the time difference between the two peaks in optical density curves recorded at the carotid artery (C3-C4 portion) and the ascending vein, after contrast material injection. Angiographic VSP was categorized using a modification of the Fisher classification.RESULTS:Angiograms for 9, 25, and 16 patients showed no, slight to moderate, and severe VSP, respectively. The MFVs of the patients with no, slight to moderate, and severe VSP were 70, 115, and 116 cm/s, respectively. No significant difference among the three groups could be observed. The mean CCTs of the patients with no, slight to moderate, and severe VSP were 4.1, 4.6, and 6.5 seconds, respectively. The CCTs of the patients with severe VSP differed significantly from those of the patients with no or slight to moderate VSP. The patients with severe VSP were divided into two groups. One group included eight patients with severe VSP at proximal sites (the internal carotid artery to the M1 segment), and the other included eight patients with severe VSP extending to the M2 segment and more peripheral sites. The mean CCT of the former group (5.3 s) was significantly different from that of the latter (7.5 s), and the MFV of the former group (128 cm/s) was significantly higher than that of the latter (81 cm/s). The clinical outcomes for the latter patients were more serious than those for the former patients.CONCLUSION:This study suggests that the MFV at the M1 segment is inadequate for estimation of the severity of VSP extending to vessels more peripheral than the M1 segment. Furthermore, severe VSP extending to more Peripheral sites can produce more serious ischemic insults, compared with that localized to basal vessels. Patients with negative TCD results and clinical features suggesting the development of VSP should undergo quantitative investigation of cerebral circulatory parameters, such as the CCT, using intra-arterial digital subtraction Angiography.

Journal

NeurosurgeryOxford University Press

Published: Sep 1, 1999

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off