Cerebral Vasospasm Affects Arterial Critical Closing Pressure

The effect of cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (SAH) on critical closing pressure (CrCP) has not been fully delineated. Using cerebral impedance methodology, we sought to assess the behavior of CrCP during CVS. As CrCP expresses the sum of intracranial pressure (ICP)...

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Bibliographic Details
Published in:Journal of cerebral blood flow and metabolism 2015-02, Vol.35 (2), p.285-291
Main Authors: Varsos, Georgios V, Budohoski, Karol P, Czosnyka, Marek, Kolias, Angelos G, Nasr, Nathalie, Donnelly, Joseph, Liu, Xiuyun, Kim, Dong-Joo, Hutchinson, Peter J, Kirkpatrick, Peter J, Varsos, Vassilis G, Smielewski, Peter
Format: Article
Language:English
Subjects:
Adult
Blood Pressure
Humans
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - physiopathology
Male
Middle Aged
Original
Prospective Studies
Retrospective Studies
Subarachnoid Hemorrhage - diagnostic imaging
Subarachnoid Hemorrhage - physiopathology
Time Factors
Ultrasonography, Doppler, Transcranial
Vasospasm, Intracranial - diagnostic imaging
Vasospasm, Intracranial - physiopathology
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Summary:The effect of cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (SAH) on critical closing pressure (CrCP) has not been fully delineated. Using cerebral impedance methodology, we sought to assess the behavior of CrCP during CVS. As CrCP expresses the sum of intracranial pressure (ICP) and vascular wall tension, we also explored its role in reflecting changes in vascular tone occurring in small vessels distal to spasm. This retrospective analysis was performed using recordings from 52 patients, diagnosed with CVS through transcranial Doppler measurements. Critical closing pressure was calculated noninvasively using arterial blood pressure and blood flow velocity. Outcome was assessed at both discharge and 3 months after ictus with the Glasgow Outcome Scale. The onset of CVS caused significant decreases in CrCP (P=0.025), without any observed significant changes in ICP (P=0.134). Vasospasm induced asymmetry, with CrCP ipsilateral to CVS becoming significantly lower than contralateral (P=0.025). Unfavorable outcomes were associated with a significantly lower CrCP after the onset of CVS (discharge: P=0.014; 3 months after SAH: P=0.020). Critical closing pressure is reduced in the presence of CVS in both temporal and spatial assessments. As ICP remained unchanged during CVS, reduced CrCP most probably reflects a lower wall tension in dilated small vessels distal to spasm.
ISSN:0271-678X
1559-7016
DOI:10.1038/jcbfm.2014.198