The effectiveness of Transcranial Doppler (TCD) in detection of vasospasm in patient with subarachnoid hemorrhage

Abstract

Aim: Vasospasm in cerebral arteries is one of the important causes of mortality and morbidity in aneurysm surgery due to ischemia and remains a current problem in neurosurgery. Controversy regarding the clinical significance of cerebral vasospasm arises from the fact that there is no acceptable, objective measure for tracking the course of vasospasm. Transcranial Doppler (TCD) is used in clinics as a practical noninvasive method to understand vasospasm. However, the effectiveness of this method, which was developed as the first noninvasive method in the detection of vasospasm, has not yet been determined. The aim of this study is to monitor vasospasm after subarachnoid hemorrhage with TCD, to compare the data with the clinical evaluation of the patient, imaging methods and Digital Subtraction Angiography (DSA) results, and to reveal the clinical diagnostic power of the TCD method. Material And Methods: For this purpose, Fisher grouping of 50 patients in our clinic, who were followed up with the diagnosis of subarachnoid, was performed. Median cerebral artery (MCA), anterior cerebral artery (ASA), posterior cerebral artery (PCA) and bacillary artery (BA) TCD were performed and analyzed according to four criteria. TCD was repeated in different situations. Vasospasm was confirmed by DSA and correlated. Results: In blood flow measurements with TCD, the most prominent spasm was seen in Fisher 3, as theoretically expected. According to Fisher, vasospasm was 31% in fisher group 2 and 27% in fisher group 3. The most prominent vasospasm in patients was detected in MCA aneurysm bleeding. The artery with the highest agreement between DSA and clinical findings was found to be MCA (94.44%). The artery with the highest agreement between angiography and TCD flow rates was BA (88%). The artery with the highest concordance between TCD flow rates and clinical findings was found to be BA (89%). Considering the postoperative examinations; BA (85%) was the artery with the highest concordance with clinical and TCD flow rates. This artery is respectively; It was followed by MCA (84%), ACA (70%), PCA (P1 and P2) (57%). Conclusion: Although there are many methods such as DSA in the detection of vasospasm in patients with subarachnoid hemorrhage, TCD has a special importance as a noninvasive method. Patients should be looked at at least once a day so that the examination can provide better guidance. For this reason, it is a fact that it will be beneficial for both the patient and the clinician to have TCD, which is a noninvasive examination, next to the patient in every intensive care unit or related clinic where patients undergoing treatment for vascular pathology are hospitalized.