Abstract
Cerebral vasospasm is a dreaded sequelae of aneurysmal subarachnoid hemorrhage (aSAH), requiring timely intervention with therapeutic goals of improving brain perfusion. There are currently no standardized real-time, objective assessments of the interventional procedures performed to treat vasospasm. Here we describe real-time techniques to quantify cerebral perfusion during interventional cerebral angiography. We retrospectively analyzed 39 consecutive cases performed to treat clinical vasospasm and quantified the changes in perfusion metrics between pre- and post- verapamil administrations. With Digital Subtraction Angiography (DSA) perfusion analysis, we are able to identify hypoperfused territories and quantify the exact changes in cerebral perfusion for each individual case and vascular territory. We demonstrate that perfusion analysis for DSA can be performed in real time. This provides clinicians with a colorized map which directly visualizes hypoperfused tissue, combined with associated perfusion statistics. Quantitative thresholds and analysis based on DSA perfusion may assist with real-time dosage estimation and help predict response to treatment, however future prospective analysis is required for validation.
Highlights
Cerebral vasospasm is a dreaded sequelae of aneurysmal subarachnoid hemorrhage, requiring timely intervention with therapeutic goals of improving brain perfusion
Inclusion criteria for this study were: (1) patients admitted with the primary diagnosis of aneurysmal subarachnoid hemorrhage (aSAH), (2) a decline in the neurological examination was identified during the vasospasm window, (3) the patient was eligible for and received IA verapamil, and (4) both pre-verapamil and post-verapamil administration angiograms were performed on the same vascular territory during the therapeutic intervention
With this work we present a methodology for real-time cerebral perfusion analysis to be performed on cerebral angiography for the evaluation of endovascular therapy for treatment of vasospasm following an aSAH
Summary
Cerebral vasospasm is a dreaded sequelae of aneurysmal subarachnoid hemorrhage (aSAH), requiring timely intervention with therapeutic goals of improving brain perfusion. There are currently no standardized real-time, objective assessments of the interventional procedures performed to treat vasospasm. With Digital Subtraction Angiography (DSA) perfusion analysis, we are able to identify hypoperfused territories and quantify the exact changes in cerebral perfusion for each individual case and vascular territory. Efficacy is assessed by a subjective assessment of the change in vascular lumen size This proxy can be misleading as radiographic vasospasm does not always correlate to clinical vasospasm or outcome, especially when cerebral perfusion is was not improved despite the IA therapy. With this work we present real-time techniques to quantify cerebral perfusion using DSA in order to quantify the efficacy of IA verapamil therapy
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