The Role of Transcranial Color Duplex Ultrasound in Endovascular Treatment of Cerebral Vasospasm

Abstract

Introduction Recent advances in neuroradiology have made it possible to perform superselective catheterization of the intracranial arteries. Intra-arterial papaverine infusion (PI) or percutaneous transluminal balloon angioplasty (PTA) can then be performed to treat vasospasm after subarachnoid hemorrhage (SAH). The purpose of this study was to determine the correlation between the angiographic result and transcranial color duplex ultrasound (TCDU) and to define a velocity threshold that could be used to predict the success of endovascular treatment for vasospasm. Methods Seven patients with SAH and symptomatic cerebral vasospasm underwent endovascular therapy and daily TCDU. PTA and/or PI was performed on a total of 23 arterial segments. Fifteen arterial segments were treated once, and eight segments required a second or third intervention. Preintervention and postintervention TCDU velocities were compared with angiographic results. Results Good to excellent relief of spasm was reported in 15 segments on the basis of postintervention angiography. The average preintervention TCDU velocity for these 15 responders was 170 cm/sec. Velocities dropped to an average of 96.5 cm/sec immediately after intervention. For the eight nonresponders, the average velocity pretreatment was 128 cm/sec. Angiography demonstrated modest or no relief of spasm after PTA or PI, and the average velocity after treatment was 130 cm/sec. When a change of >25 cm/sec was used, TCDU correctly predicted angiographic responders with a p value of < 0.01. Conclusions Our data demonstrate a strong correlation between the angiographic result and the drop in velocity after endovascular therapy for vasospasm. Postintervention TCDU values can be used as a point of reference from which to monitor further progression or regression of vasospasm. We believe that TCDU has significant value in the management decisions of endovascular interventions for the treatment of cerebral vasospasm.