Abstract
Delayed cerebral ischemia (DCI) secondary to vasospasm is a determinate of outcomes following non-traumatic subarachnoid hemorrhage (SAH). SAH patients are monitored using transcranial doppler (TCD) to measure cerebral blood flow velocities (CBFv). However, the accuracy and precision of manually acquired TCD can be operator dependent. The NovaGuide robotic TCD system attempts to standardize acquisition. This investigation evaluated the safety and efficacy of the NovaGuide system in SAH patients in a Neuro ICU. We retrospectively identified 48 NovaGuide scans conducted on SAH patients. Mean and maximum middle cerebral artery (MCA) CBFv were obtained from the NovaGuide and the level of agreement between CBFv and computed tomography angiography (CTA) for vasospasm was determined. Safety of NovaGuide acquisition of CBFv was evaluated based on number of complications with central venous lines (CVL) and external ventricular drains (EVD). There was significant agreement between the NovaGuide and CTA (Cohen’s Kappa = 0.74) when maximum MCA CBFv ≥ 120 cm/s was the threshold for vasospasm. 27/48 scans were carried out with CVLs and EVDs present without negative outcomes. The lack of adverse events associated with EVDs/CVLs and the strong congruence between maximal MCA CBFv and CTA illustrates the diagnostic utility of the NovaGuide.
Highlights
Delayed cerebral ischemia (DCI) secondary to vasospasm is a determinate of outcomes following non-traumatic subarachnoid hemorrhage (SAH)
Vasospasm is the narrowing of the cerebral arteries and is a common complication of SAH that can lead to delayed cerebral ischemia (DCI), with DCI leading to poor patient outcomes and is associated with morbidity and mortality following SAH2,3
Digital subtraction angiography (DSA), and increasingly computer tomography angiography (CTA) are considered the gold standard for determination of cerebral vasospasm as it allows for clear visualization of v asculature[4]
Summary
Delayed cerebral ischemia (DCI) secondary to vasospasm is a determinate of outcomes following non-traumatic subarachnoid hemorrhage (SAH). SAH patients are monitored using transcranial doppler (TCD) to measure cerebral blood flow velocities (CBFv). The NovaGuide robotic TCD system attempts to standardize acquisition This investigation evaluated the safety and efficacy of the NovaGuide system in SAH patients in a Neuro ICU. TCD offers a safe, relatively inexpensive, and repeatable alternative to CTA to measure cerebral blood flow velocity (CBFv) by insonating proximal cerebral arteries, enabling the identification of vasospasm and ischemia[5]. The NovaGuide system uses a headset that automatically moves the transducer, eliminating variability between users This allows the system to be used without a trained sonographer while providing consistent results. We sought to evaluate the safety and validity of the NovaGuide in patients with SAH
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