Neurocritical Care

, Volume 25, Issue 1, pp 40–46 | Cite as

Real-Time, In Vivo Monitoring, and Quantitative Assessment of Intra-Arterial Vasospasm Therapy

  • Philipp Gölitz
  • Iris Kaschka
  • Stefan Lang
  • Karl Roessler
  • Frauke Knossalla
  • Arnd Doerfler
Original Article
First Online:

Abstract

Background

Our study aimed to evaluate whether the effect of an intra-arterial vasospasm therapy can be assessed quantitatively by in vivo blood flow analysis using the postprocessing algorithm parametric color coding (PCC).

Methods

We evaluated 17 patients presenting with acute clinical deterioration due to vasospasm following subarachnoidal hemorrhage treated with intra-arterial nimodipine application. Pre- and post-interventional DSA series were post-processed by PCC. The relative time to maximum opacification (rTmax) was calculated in 14 arterially and venously located points of interest. From that data, the pre- and post-interventional cerebral circulation time (CirT) was calculated. Additionally, the arterial vessel diameters were measured. Pre- and post-interventional values were compared and tested for significance, respectively.

Results

Flow analysis revealed in all arterial vessel segments a non-statistically significant prolongation of rTmax after treatment. The mean CirT was 5.62 s (±1.19 s) pre-interventionally and 5.16 s (±0.81 s) post-interventionally, and the difference turned out as statistically significant (p = 0.039). A significantly increased diameter was measurable in all arterial segments post-interventionally.

Conclusion

PCC is a fast applicable imaging technique that allows via real-time and in vivo blood flow analysis a quantitative assessment of the effect of intra-arterial vasospasm therapy. Our results seem to validate in vivo that an intra-arterial nimodipine application induces not only vasodilatation of the larger vessels, but also improves the microcirculatory flow, leading to a shortened cerebral CirT that reaches normal range post-interventionally. Procedural monitoring via PCC offers the option to compare quantitatively different therapy regimes, which allows optimization of existing approaches and implementation of individualized treatment strategies.

Keywords

Vascular disease Subarachnoidal hemorrhage Cerebral vasospasm Endovascular treatment Image postprocessing 

Abbreviations

ap

Anterior–posterior

CirT

Cerebral circulation time

DSA

Digital subtraction angiography

ICA

Internal carotid artery

PCC

Parametric color coding

SAH

Subarachnoidal hemorrhage

rTmax

Relative time to maximum opacification

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Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Philipp Gölitz
    • 1
  • Iris Kaschka
    • 1
  • Stefan Lang
    • 1
  • Karl Roessler
    • 2
  • Frauke Knossalla
    • 3
  • Arnd Doerfler
    • 1
  1. 1.Department of NeuroradiologyUniversity of Erlangen-NurembergErlangenGermany
  2. 2.Department of NeurosurgeryUniversity of Erlangen-NurembergErlangenGermany
  3. 3.Department of NeurologyUniversity of Erlangen-NurembergErlangenGermany

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