Abstract
Background and Purpose: We evaluated optimal transcranial Doppler (TCD) measures for predicting delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH).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.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.
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