Basilar artery vasospasm: diagnosis and grading by transcranial Doppler
The aim of the study is to better define transcranial Doppler (TCD) criteria for posterior circulation vasospasm. Basilar artery (BA) diameters were measured and compared with diameters obtained from baseline arteriograms in 144 artheriographies done in p
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Basilar artery vasospasm: diagnosis and grading by transcranial Doppler G. E. Sviri1 , M. Zaaroor1, G. W. Britz2 , C. M. Douville3 , A. Lam2 , D. W. Newell3 1
Rambam (Maimonides) Medical Centre, Department of Neurosurgery, Haifa, Israel Harborview Medical Centre, Department of Neurological Surgery and Anesthesiology, University of Washington, Seattle, WA, U.S.A. 3 Swedish Medical Center=Providence Campus, Seattle Neuroscience Institute, Seattle, WA, U.S.A. 2
Summary The aim of the study is to better define transcranial Doppler (TCD) criteria for posterior circulation vasospasm. Basilar artery (BA) diameters were measured and compared with diameters obtained from baseline arteriograms in 144 artheriographies done in patients with aneurysmal subarachnoid haemorrhage (SAH). Both BA and extracranial vertebral artery (ECVA) flow velocities (FV) were measured by TCD in order to obtain an intracranial=extracranial flow velocities ratio. The velocity ratio between the basilar artery and the extracranial vertebral arteries (BA=VA) strongly correlated with the degree of BA narrowing (p < 0.0001). A ratio higher than 2.0 was associated with 73% sensitivity and 80% specificity for BA vasospasm. A ratio higher than 2.5 with BA velocity greater than 85 cm=sec was associated with 86% sensitivity and 97% specificity for BA narrowing of more than 25%. A BA=VA ratio higher than 3.0 with BA velocities higher than 85 cm=sec was associated with 92% sensitivity and 97% specificity for BA narrowing of more than 50%. Our data show that the BA=VA ratio improves the sensitivity and specificity of TCD detection of BA vasospasm.
arteries, that significantly improved the specificity and sensitivity of TCD for the diagnosis of basilar artery vasospasm. The aim of the present study was to define the TCD grading criteria for basilar artery using an IC=EC flow velocity ratio method, as suggested by Soustiel et al. [9]. Methods and materials Patients
Keywords: Angiography; basilar artery; transcranial Doppler; subarachnoid haemorrhage; vasospasm.
One hundred and twenty-three patients (demographic and clinical data are presented in Table 1) with aneurysmal subarachnoid haemorrhage (SAH) had 4 vessel diagnostic angiography done within 48 h of initial bleeding, which did not show narrowing, stenosis or occlusion of the vertebral or basilar arteries. A second arteriogram with views of the basilar artery was done within the risk period for vasospasm (days 3–12 following initial haemorrhage). All patients received daily TCD measurements of the posterior circulation arteries, including measurements of the extracranial vertebral arteries.
Introduction
Angiography study
Lindegaard et al. [4] suggested transcranial Doppler (TCD) criteria for the diagnosis of vasospasm in the anterior circulation based on intracranial to extracranial (IC=EC) flow velocity ratios (FV), which improved the sensitivity of TCD to detect arterial narrowing. Sloan et al. [6] suggested the criteria for the diagnosis of vasospasm in the posterior circulation using TCD based on f
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