gms | German Medical Science

Objective: The detection of hemodynamically relevant vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is essential before an invasive treatment can be initiated, in order to prevent cerebral infarction and permanent neurological deficits. The aim of this study was to evaluate the correlation of perfusion deficits detected by CT perfusion (CTP) with angiographic vasospasm identified by CT angiography (CTA) as a noninvasive diagnostic technique to detect cerebral vasospasm in patients with aSAH.

Method: In 43 consecutive patients with aSAH, whole brain volume CTP was performed for early (<DAY5) identification „tissue risk“. In 26 these has been conducted combination CTP, 13 patients had at least two further CTA scans during period (day5 to day 14). Qualitative quantitative measurements deficits, angiographic were explored. Furthermore, correlation between vessel territories with perfusion deficits identified CTP and the CT-angiographic location of vasospasm evaluated. Daily neurological assessment well transcranial Doppler sonography (TCD) bedside screening method performed in every patient, whereas TCD-vasospasm was defined as mean blood flow velocities >120 cm/s.

Results: We analyzed a total of 45 CTP and CTA data in 27 patients with aSAH. The mean age of the patients was 51.4 yrs (range 29–71). Seventeen patients were female, 10 male. Territorial perfusion deficits were seen on 23 CTPs in 12 patients. In 73% (17/23) of the CTP scans, a correlation of the vessel territory with perfusion deficits and the location of angiographic vasospasm was found. All 12 patients developed delayed ischemic neurological deficits (DIND), whereas only 6 of them had shown increased blood flow velocities measured by TCD at the same time. Five of the 12 patients with perfusion deficits received endovascular treatment by means of balloon angioplasty.

Conclusions: The combination of CTP and CTA shows a high correlation between the location of „tissue at risk“ identified as perfusion deficits, and the vessel territory with angiographic vasospasm. Hence, it seems to be a promising noninvasive guide of the decision making for invasive treatment in patients with aSAH.