Abstract Body: Background and Purpose: Transcranial Doppler (TCD) has been widely used to predict cerebral vasospasm in subarachnoid hemorrhage (SAH) patients by monitoring the mean flow velocity (MFV) of major cerebral arteries. However, the accuracy of TCD in identifying specific arteries with vasospasm is questionable. This study investigates the correlation between elevated MFVs in TCD and actual vasospasm locations, evaluating the influence of adjacent artery vasospasms.
Materials and Methods: We conducted a retrospective observational study. Between March 2017 and December 2020, 256 SAH patients admitted to our hospital underwent TCD monitoring. The presence and arterial distribution of vasospasm were confirmed via conventional angiography. Statistical analysis included bivariate mixed-effects linear regression and logistic regression to explore the relationships between the MFV values and the presence and location of vasospasms.
Results: Of the 256 patients, 188 met the study criteria, yielding 367 hemispheres for analysis. Significant correlations were found between the MFV values of the middle cerebral artery (MCA), anterior cerebral artery (ACA), and internal carotid artery (ICA). Vasospasm was associated with elevated MFVs not only in the directly affected arteries but also in adjacent ones. Logistic regression indicated a significant association between the presence of vasospasm and increased MFV in the respective artery. However, ACA vasospasm showed significant associations only with elevated MCA MFV.
Conclusion: These findings challenge the traditional assumption made with TCDs that MFV increases correlate with vasospasm in the corresponding artery. Rather, elevated MFVs should be considered a general marker of potential vasospasm within the anterior cerebral circulation. This study underscores the interconnected response of cerebral arteries to vasospasm and the need for comprehensive evaluation when elevated MFV is observed.