NEUROIMAGING / NEUROSONOLOGY

TCD/TCCD vasospasm monitoring

Created 31/03/2021, last revision 29/04/2023

• vasospasm is a contraction of the muscular wall of an artery, resulting in its stenosis and reduced flow
• the prevalence of vasospasms (VSP) following SAH is 50-70%
• vasospasms in SAH patients occur around day 3-5 and last up to 3-4 weeks
• approximately 30% of patients with aneurysmal SAH develop delayed ischemic deficit (DID) (Yamaki, 2019)
  
  • DID is the leading preventable cause of a poor outcome
• increased risk of VSP is associated with:
  • higher Hunt-Hess and Fisher scores
  • baseline blood pressure
    
  • fluid depletion
  • low ejection fraction (EF)
    
• the risk of complications increases with the number of arteries involved and with hemodynamically significant spasms

Vasospasms Detection and Monitoring

• neurosonology (TCCD/TCD)
  • optimal bedside, cost-effective and non-invasive method
• CT angiography
  • CT perfusion imaging (CTP) may help predict DID
• MR angiography
  • low sensitivity for the diagnosis of distal ICA vasospasms
  • MR perfusion may help predict DID
• digital subtraction angiography (DSA)
  • only when subsequent local endovascular treatment is indicated

TCCD Criteria