Ultra-early Detection of Microcirculatory Injury as Predictor of Developing Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage.

Abstract

Delayed cerebral ischemia (DCI) still remains amajor complication after subarachnoid hemorrhage (SAH). The aim of our study was to evaluate whether flow analysis of admission digital subtraction angiography (DSA) using parametric color coding (PCC), apostprocessing algorithm, allows ultra-early identification of SAH patients at risk for developing subsequent symptomatic vasospasm. In this study 52patients who suffered SAH from aneurysm rupture, were retrospectively enrolled. Of the patients 26 developed DCI and angiographically proven cerebral vasospasm and 26age, gender-and clinical status-matched SAH patients without DCI served as controls. Using PCC, the following flow parameters were calculated: cerebral circulation time (CirT), cortical relative time to peak (rTTP) and microvascular transit time (TT). Mean cerebral CirT and cortical rTTP were longer in the DCI group (6.42 s± 1.54 and 3.16 s± 0.86, respectively) than in the non-DCI group (5.77 s± 1.86 and 3.11 s± 1.41, respectively), but without statistical significance. The mean microvascular TT was statistically significantly (p= 0.04) longer in the DCI group (3.19 s± 0.78) than in the non-DCI group (2.67 s± 0.73). Angiographic flow analysis might be suitable for ultra-early detection and quantitative assessment of microcirculatory injury in SAH patients, predictive of developing subsequent DCI. Prolonged microvascular TT seems to be asignificant independent factor positively associated with DCI development. Identifying SAH patients at risk for DCI ultra-early after ictus might contribute to initiate prophylactic therapies before clinical deterioration.