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Research Articles
Vasilios Papaioannou
Democritus University of Thrace Department of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2637-0160
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Cerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial doppler (TCD)-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia.
Methods
A retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in 2 groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Complexity of CBFV was estimated through measurement of sample entropy (SampEn).
Results
In the whole population (N=32), magnitude of SWs of ipsilateral to VS side CBFV was higher during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/sec, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group ( N =19, p < 0.001) and were strongly predictive of DCI, with area under the curve (AUC) = 0.745 (p = 0.02). Vasospasm caused a non-significant shortening of ipsilateral values of tau and increase in SampEn in all patients related to pre VS measurements, as well as an insignificant increase of Mxa in DCI related to non-DCI group (N = 13).
Conclusions
In patients suffering from subarachnoid hemorrhage, TCD-detected VS was associated with higher ipsilateral CBFV SWs, related to pre-VS measurements. Higher CBFV SWs before VS were significantly predictive of delayed cerebral ischemia.
Keywords
Cerebral blood flow, delayed cerebral ischemia, subarachnoid hemorrhage, slow waves, time constant, transcranial doppler, vasospasm
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CURRENT STATUS: Published
View the published article at Intensive Care Medicine Experimental.
Version 2
Posted 04 Feb, 2021
No community comments so far
Review #1 received
Received 08 Feb, 2021
Reviewer #2 agreed
On 28 Jan, 2021
Reviewers invited
Invitations sent on 27 Jan, 2021
Reviewer #1 agreed
On 27 Jan, 2021
Editor assigned
On 26 Jan, 2021
Submission checks complete
On 26 Jan, 2021
Editor invited
On 26 Jan, 2021
No comments provided
Editorial decision: Major revision
On 09 Jan, 2021
Review #2 received
Received 28 Dec, 2020
Review #1 received
Received 28 Dec, 2020
Reviewer #2 agreed
On 05 Dec, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 08 Nov, 2020
Editor assigned
On 04 Nov, 2020
Submission checks complete
On 04 Nov, 2020
Editor invited
On 04 Nov, 2020
First submitted
On 03 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
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A new preprint design is coming!
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See the published version of this preprint at Intensive Care Medicine Experimental.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Articles
Vasilios Papaioannou
Democritus University of Thrace Department of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2637-0160
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Intensive Care Medicine Experimental.
Version 2
Posted 04 Feb, 2021
No community comments so far
Review #1 received
Received 08 Feb, 2021
Reviewer #2 agreed
On 28 Jan, 2021
Reviewers invited
Invitations sent on 27 Jan, 2021
Reviewer #1 agreed
On 27 Jan, 2021
Editor assigned
On 26 Jan, 2021
Submission checks complete
On 26 Jan, 2021
Editor invited
On 26 Jan, 2021
No comments provided
Editorial decision: Major revision
On 09 Jan, 2021
Review #2 received
Received 28 Dec, 2020
Review #1 received
Received 28 Dec, 2020
Reviewer #2 agreed
On 05 Dec, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 08 Nov, 2020
Editor assigned
On 04 Nov, 2020
Submission checks complete
On 04 Nov, 2020
Editor invited
On 04 Nov, 2020
First submitted
On 03 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Intensive Care Medicine Experimental.
Background
Cerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial doppler (TCD)-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia.
Methods
A retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in 2 groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Complexity of CBFV was estimated through measurement of sample entropy (SampEn).
Results
In the whole population (N=32), magnitude of SWs of ipsilateral to VS side CBFV was higher during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/sec, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group ( N =19, p < 0.001) and were strongly predictive of DCI, with area under the curve (AUC) = 0.745 (p = 0.02). Vasospasm caused a non-significant shortening of ipsilateral values of tau and increase in SampEn in all patients related to pre VS measurements, as well as an insignificant increase of Mxa in DCI related to non-DCI group (N = 13).
Conclusions
In patients suffering from subarachnoid hemorrhage, TCD-detected VS was associated with higher ipsilateral CBFV SWs, related to pre-VS measurements. Higher CBFV SWs before VS were significantly predictive of delayed cerebral ischemia.
Figure 1
Figure 2
Figure 3
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