Document Detail


Relationship between angiographic vasospasm and regional hypoperfusion in aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  22492520     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Angiographic vasospasm frequently complicates subarachnoid hemorrhage and has been implicated in the development of delayed cerebral ischemia. Whether large-vessel narrowing adequately accounts for the critical reductions in regional cerebral blood flow underlying ischemia is unclear. We sought to clarify the relationship between angiographic vasospasm and regional hypoperfusion.
METHODS: Twenty-five patients with aneurysmal subarachnoid hemorrhage underwent cerebral catheter angiography and 15O-positron emission tomographic imaging within 1 day of each other (median of 7 days after subarachnoid hemorrhage). Severity of vasospasm was assessed in each intracranial artery, whereas cerebral blood flow and oxygen extraction fraction were measured in 28 brain regions distributed across these vascular territories. We analyzed the association between vasospasm and perfusion and compared frequency of hypoperfusion (cerebral blood flow<25 mL/100 g/min) and oligemia (low oxygen delivery with oxygen extraction fraction≥0.5) in territories with versus without significant vasospasm.
RESULTS: Twenty-four percent of 652 brain regions were supplied by vessels with significant vasospasm. Cerebral blood flow was lower in such regions (38.6±12 versus 48.7±16 mL/100 g/min), whereas oxygen extraction fraction was higher (0.48±0.19 versus 0.37±0.14, both P<0.001). Hypoperfusion was seen in 46 regions (7%), but 66% of these were supplied by vessels with no significant vasospasm; 24% occurred in patients without angiographic vasospasm. Similarly, oligemia occurred more frequently outside territories with vasospasm.
CONCLUSIONS: Angiographic vasospasm is associated with reductions in cerebral perfusion. However, regional hypoperfusion and oligemia frequently occurred in territories and patients without vasospasm. Other factors in addition to large-vessel narrowing must contribute to critical reductions in perfusion.
Authors:
Rajat Dhar; Michael T Scalfani; Spiros Blackburn; Allyson R Zazulia; Tom Videen; Michael Diringer
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-04-05
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  43     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-26     Completed Date:  2012-09-04     Revised Date:  2014-09-09    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1788-94     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Blood Flow Velocity / physiology*
Cerebral Angiography* / methods
Cerebrovascular Circulation / physiology*
Female
Humans
Male
Middle Aged
Positron-Emission Tomography / methods
Retrospective Studies
Subarachnoid Hemorrhage / physiopathology,  radiography*
Vasospasm, Intracranial / physiopathology,  radiography*
Grant Support
ID/Acronym/Agency:
5P50NS35966-10/NS/NINDS NIH HHS; P50 NS035966/NS/NINDS NIH HHS; P50 NS035966-10/NS/NINDS NIH HHS; P50 NS055977/NS/NINDS NIH HHS; P50 NS055977-03/NS/NINDS NIH HHS; TL1 TR000449/TR/NCATS NIH HHS; UL1 RR024992/RR/NCRR NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Baseline cardiovascular risk predicts subsequent changes in resting brain function.
Next Document:  Clinical and pathological improvement in stroke-prone spontaneous hypertensive rats related to the p...