NEUROIMAGING / NEUROSONOLOGY

TCD/TCCD vasospasm monitoring

Created 31/03/2021, last revision 20/01/2023

  • 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 between 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 poor outcome
  • increased risk of VSP is associated with:
  • the risk of complications increases with the number of affected arteries and with hemodynamically significant spasms

Vasospasms Detection and Monitoring

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

TCCD Criteria

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TCD/TCCD vasospasm monitoring
link: https://www.stroke-manual.com/tccd-vasospasm-monitoring/