Transcranial Doppler velocity and associations with delayed cerebral ischemia in aneurysmal subarachnoid Hemorrhage.

MedStar author(s):
Citation: Journal of the Neurological Sciences. 415:116934, 2020 May 20.PMID: 32526525Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Neurosurgery | Radiology | Surgery/Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020ISSN:
  • 0022-510X
Name of journal: Journal of the neurological sciencesAbstract: BACKGROUND AND PURPOSE: We evaluated optimal transcranial Doppler (TCD) measures for predicting delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH).CONCLUSIONS: We found that relative increases in TCD velocities in the MCAs during the first 7 days (with a threshold increase of 53.4 cm/s from days 2 to 7) after aSAH admission were independently associated with DCI. This association requires independent confirmation. Copyright (c) 2020 Elsevier B.V. All rights reserved.MATERIAL AND METHODS: Consecutive patients with aSAH and daily middle cerebral artery (MCA) TCD recordings were retrospectively analyzed. Change in TCD velocity was obtained by creating a smoothing curve. Change in TCD velocity was determined with a linear regression model that confirmed greatest change in velocity associated with DCI occurred at days 2-7. Multivariate logistic regression analysis was then completed.RESULTS: 95 patients were evaluated. Increase in TCD velocity at days 2-7 proved to be the best predictor for DCI with an optimal cutoff of 8.9 cm/s/day (p = .019) and AUC 0.651. Multivariate logistic regression analysis using DCI as outcome showed that poor admission Hunt-Hess scores (OR 5.02, 95%CI 1.22-22.67, p = .028) and increases in TCD velocity (OR 5.32, 95%CI 1.41-23.33, p = .018) were independently associated with DCI.All authors: Armonda RA, Aulisi EF, Chang JJ, Corbin MJ, Desale S, Felbaum DR, Liu AH, Mai JC, Triano MFiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-08-26
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Journal Article MedStar Authors Catalog Article 32526525 Available 32526525

BACKGROUND AND PURPOSE: We evaluated optimal transcranial Doppler (TCD) measures for predicting delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH).

CONCLUSIONS: We found that relative increases in TCD velocities in the MCAs during the first 7 days (with a threshold increase of 53.4 cm/s from days 2 to 7) after aSAH admission were independently associated with DCI. This association requires independent confirmation. Copyright (c) 2020 Elsevier B.V. All rights reserved.

MATERIAL AND METHODS: Consecutive patients with aSAH and daily middle cerebral artery (MCA) TCD recordings were retrospectively analyzed. Change in TCD velocity was obtained by creating a smoothing curve. Change in TCD velocity was determined with a linear regression model that confirmed greatest change in velocity associated with DCI occurred at days 2-7. Multivariate logistic regression analysis was then completed.

RESULTS: 95 patients were evaluated. Increase in TCD velocity at days 2-7 proved to be the best predictor for DCI with an optimal cutoff of 8.9 cm/s/day (p = .019) and AUC 0.651. Multivariate logistic regression analysis using DCI as outcome showed that poor admission Hunt-Hess scores (OR 5.02, 95%CI 1.22-22.67, p = .028) and increases in TCD velocity (OR 5.32, 95%CI 1.41-23.33, p = .018) were independently associated with DCI.

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