Artikel
Vessel dimension and reactivity in the acute phase of aneurysmal and non-aneurysmal subarachnoid hemorrhage
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Autoren
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Charlotte Zaeske
- Department of Neurosurgery, RWTH Aachen University, Aachen, Deutschland
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Catharina Conzen
- Universitätsklinikum der RWTH Aachen, Neurochirurgische Klinik, Aachen, Deutschland
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Walid Albanna
- Department of Neurosurgery, RWTH Aachen University, Aachen, Deutschland
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Konstantin Kotliar
- Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Aachen, Deutschland
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Hans Rainer Clusmann
- Universitätsklinikum der RWTH Aachen, Neurochirurgische Klinik, Aachen, Deutschland
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Anke Hoellig
- Department of Neurosurgery, RWTH Aachen University, Aachen, Deutschland
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Gerrit A. Schubert
- Department of Neurosurgery, RWTH Aachen University, Aachen, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
Text
Objective: Despite comparable initial imaging findings in both aneurysmal and non-aneurysmal subarachnoid haemorrhage (aSAH, naSAH), the clinical course of patients with naSAH is usually benign, implying a significant difference in the underlying pathophysiology. Recent data suggests early alterations of vessel diameter and responsiveness (neurovascular coupling = NVC) in aneurysmal SAH as documented by non-invasive retinal vessel analysis (RVA). Using RVA, we evaluated differences in vessel dimension and the integrity of NVC in patients with aSAH and naSAH in the early phase after rupture.
Methods: In a prospective study, we performed RVA in 13 patients with aSAH (HH I-III°, mean age 53.8±12yrs) and nine patients with naSAH (mean age 54.8±8.4yrs) within the early phase after hemorrhage (day 1-4) and included 35 age-matched healthy controls. Data was acquired using a Dynamic Vessel Analyzer (Imedos Systems UG, Jena) for examination of retinal vessel dimension and neurovascular coupling (NVC) using flicker-light excitation (FLE).
Results: Retinal arteries were significantly dilated only in patients with aSAH (p<0.01), whereas patients with naSAH featured vessels dimensions comparable to healthy controls. Early arterial dilatation may be interpreted as a reflectory response to a more pronounced metabolic demand in aSAH patients. Compared to healthy controls, neurovascular coupling was impaired in both aSAH and naSAH patients, as documented by diminished (aSAH: p<0.001; naSAH: p<0.01) and delayed (aSAH: p<0.001; naSAH: p<0.001) vasodilatory response.
Conclusion: To our knowledge, this is the first clinical study to compare retinal vessel dimension and reactivity after aneurysmal and non-aneurysmal SAH. Using retinal vessel analysis, initial vasodilation is observed only in patients with aneurysmal SAH, possibly indicative of an increased metabolic demand. Neurovascular coupling is impaired in both hemorrhage entities. Recruitment will continue to facilitate a more detailed correlation analysis with clinical course and outcome.
