Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study.

Marianne Lundervik Bøthun,Nicola Logallo,Øystein Ariansen Haaland,Frode Svendsen,Lars Thomassen,Christian A Helland

doi:10.1155/2018/6489276

Marianne Lundervik Bøthun, Nicola Logallo + Show 4 more

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https://doi.org/10.1155/2018/6489276

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Abstract

Background Cerebrovascular reactivity (CVR) is often impaired in the early phase after aneurysmal subarachnoid hemorrhage. There is, however, little knowledge about the time course of CVR in patients treated for unruptured intracranial aneurysms (UIA). Methods CVR, assessed by transcranial Doppler and acetazolamide test, was examined within the first postoperative week after treatment for UIA and reexamined one year later. Results Of 37 patients initially assessed, 34 were reexamined after one year. Bilaterally, baseline and acetazolamide-induced blood flow velocities were higher in the postoperative week compared with one year later (p < 0.001). CVR on the ipsilateral side of treatment was lower in the initial examination compared with follow-up (58.9% versus 66.1%, p = 0.04). There was no difference in CVR over time on the contralateral side (63.4% versus 65.0%, p = 0.65). When mean values of right and left sides were considered there was no difference in CVR between exams. Larger aneurysm size was associated with increased change in CVR (p = 0.04), and treatment with clipping was associated with 13.8%-point increased change in CVR compared with coiling (p = 0.03). Conclusion Patients with UIA may have a temporary reduction in CVR on the ipsilateral side after aneurysm treatment. The change in CVR appears more pronounced for larger-sized aneurysms and in patients treated with clipping. We recommend that ipsilateral and contralateral CVR should be assessed separately, as mean values can conceal side-differences.

Highlights

Constriction and dilation of cerebral arterioles regulate cerebral blood flow
Of 37 patients examined in the initial study, two patients chose to abstain from the follow-up test due to side effects of AZ at the initial examination, and one patient did not meet for follow-up due to long travel to the hospital
All other variables listed in the table were recorded at the time of aneurysm treatment

Summary

Introduction

Constriction and dilation of cerebral arterioles regulate cerebral blood flow. Cerebrovascular reactivity (CVR) reflects this regulating capacity and is a marker of cerebrovascular integrity. There is, little knowledge regarding the time course of CVR in patients with unruptured intracranial aneurysms (UIA). It is unknown whether, and how, aneurysm treatment affects CVR. Information on the time course of CVR in patients treated for UIA may help in differentiating between potential effects of aneurysm treatment and the impact of an aneurysm bleeding. There is, little knowledge about the time course of CVR in patients treated for unruptured intracranial aneurysms (UIA). CVR, assessed by transcranial Doppler and acetazolamide test, was examined within the first postoperative week after treatment for UIA and reexamined one year later. Patients with UIA may have a temporary reduction in CVR on the ipsilateral side after aneurysm treatment. We recommend that ipsilateral and contralateral CVR should be assessed separately, as mean values can conceal side-differences

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