The Value of CT Angiography and Transcranial Doppler Sonography in Triaging Suspected Cerebral Vasospasm in SAH Prior to Endovascular Therapy

Ionita, Catalina C.; Graffagnino, Carmelo; Alexander, Michael J.; Zaidat, Osama O.

doi:10.1007/s12028-007-9029-8

Cited by 29 publications

(16 citation statements)

References 16 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Not all patients in the study underwent CTA and/or direct cerebral angiography to diagnose vasospasm, but, consistent with the literature, there were no cases where vasospasm was identified by CTA or angiography, and was also not identified by the combination of neurological examination and TCD ultrasonography. 8 Although the trial was stopped early and there was no statistically significant difference in the primary outcome of vasospasm, there was a trend toward significance in favor of the open-EVD group. It is not possible to know what the final rates of vasospasm would have been if the trial had been allowed to continue to full enrollment.…”

Section: 9mentioning

confidence: 96%

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Olson

Zomorodi

Britz

et al. 2013

JNS

Self Cite

View full text Add to dashboard Cite

Object Cerebral artery vasospasm is a major cause of death and disability in patients recovering from subarachnoid hemorrhage (SAH). Although the exact cause of vasospasm is unknown, one body of research suggests that clearing blood products by CSF drainage is associated with a lower frequency and severity of vasospasm. There are multiple approaches to facilitating CSF drainage, but there is inadequate evidence to determine the best practice. The purpose of this study was to explore whether continuous or intermittent CSF drainage was superior for reducing vasospasm. Methods The authors performed a randomized clinical trial. Within 72 hours of admission for SAH, patients with an external ventricular drain (EVD) were randomized to undergo continuous CSF drainage with intermittent intracranial pressure (ICP) monitoring (open-EVD group) or continuous ICP monitoring with intermittent CSF drainage (monitor-ICP group). Results After 60 patients completed the study, an interim analysis was performed. The complication rate of 52.9% for the open-EVD group was significantly higher than the 23.1% complication rate for the monitor-ICP group (OR 3.75, 95% CI 1.21–11.66, p = 0.022). These results were reported to the Data Safety and Monitoring Board and enrollment was terminated. The odds ratio of vasospasm for the open-EVD versus monitor-ICP group was not significant (OR 0.44, 95% CI 0.13–1.45, p = 0.177). Conclusions Continuous CSF drainage with intermittent ICP monitoring is associated with a higher rate of complications than continuous ICP monitoring with intermittent CSF drainage, but there is no difference between the two types of monitoring in vasospasm. Clinical trial registration no.: NCT01169454 (clinicaltrials.gov).

show abstract

Section: 9mentioning

confidence: 96%

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Olson

Zomorodi

Britz

et al. 2013

JNS

Self Cite

View full text Add to dashboard Cite

show abstract

“…1,7,16,18,25,28,40,45 Transcranial Doppler ultrasonography is probably the most common noninvasive method but provides little quantitative information, thereby limiting one's ability to use it for grading severity of the lesion; it can produce false-positive results when patients are given medications that increase blood pressure. The use of CT angiography and CT perfusion scanning has increased use over recent years due to their more widespread availability as well as literature support.…”

mentioning

confidence: 99%

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Eddleman

Hurley

Naidech

et al. 2009

FOC

View full text Add to dashboard Cite

The second leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH) is delayed cerebral ischemia due to vasospasm. Although up to 70% of patients have been shown to have angiographic evidence of vasospasm, only 20–30% will present with clinical changes, including mental status changes and neurological deficits that necessitate acute management. Endovascular capabilities have progressed to become viable options in the treatment of cerebral vasospasm. The rationale for intraarterial therapy includes the fact that morbidity and mortality rates have not changed in recent years despite optimized noninvasive medical care. In this report, the authors discuss the most common endovascular options—namely intraarterial vasodilators and transluminal balloon angioplasty—from the standpoint of mechanism, efficacy, limitations, and complications as well as the treatment algorithms for cerebral vasospasm used at our institution.

show abstract

“…Correlations between transcranial Doppler and CT angiography are good for patients with severe vasospasms (PMV > 180 cm/sec) and for patients without vasospasms (PMV < 140 cm/ sec) in the study by IONITA (20). On the other hand, correlations are less good for patients with asymptomatic spasms or with intermediate velocities and the authors recommend CT angiography in this case.…”

Section: Transcranial Dopplermentioning

confidence: 83%

Vasospasm and Delayed Consequences

Bracard

Schmitt

2008

Interv Neuroradiol

View full text Add to dashboard Cite

The Value of CT Angiography and Transcranial Doppler Sonography in Triaging Suspected Cerebral Vasospasm in SAH Prior to Endovascular Therapy

Abstract: Clinical evaluation and TCD can reliably diagnose CVS in symptomatic patients and PMV >180 cm/s, or can rule out CVS in asymptomatic patients with PMV <140 cm/s. In this category of patients, adding a CTA to clinical evaluation and TCD may not be warranted.

Cited by 29 publications

References 16 publications

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Vasospasm and Delayed Consequences

Contact Info

Product

Resources

About