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
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