Lammers, T. (2020) Relative changes in mean flow velocity are promising to exclude the occurrence of cerebral infarction after subarachnoid hemorrhage. thesis, Medicine.
Full text available on request.Abstract
Introduction Delayed cerebral ischemia (DCI) is a severe secondary complication after an aneurysmal subarachnoid hemorrhage (aSAH). The optimal strategy to detect DCI remains debatable. The aim of this study was to assess whether alternative transcranial Doppler (TCD) criteria based on change in mean flow velocity (MFV) are predictive of DCI, cerebral infarction and unfavorable functional outcomes. Method In this post-hoc analysis of the TACTICS study (prospective study on the diagnostic accuracy of TCD and CT-angiography in predicting DCI and functional outcome), all TCD data of aSAH patients was used. Absolute and relative increases in MFV were calculated in addition to conventional diagnostic criteria for aSAH and their discriminative abilities were analyzed. Optimal cutoff points were determined using the Youden index. Associations between the outcome variables, different diagnostic criteria and baseline characteristics were assessed in multivariate logistic regression analysis. Results Data from 59 patients was analyzed. Relative increase in MFV (RFC) of the middle cerebral artery (MCA) predicting cerebral infarction was the best predictor of all criteria based on change in MFV (Area under the curve (AUC) 0.69, p=0.052) with an optimal cutoff value of 3.4 (sensitivity of 46%, negative predictive value of 88%). The Lindegaard ratio at day 5 was the best predictor of cerebral infarction (AUC 0.70, p=0.04) and had the highest predictive values. Both criteria were not significantly different from each other (p=0.48). Multivariate logistic regression analysis showed that only the RFC of the MCA (dichotomized at 3.4) was independently associated with cerebral infarction (odds ratio 13.4 (95% CI 2.0-90.5), p=0.01). Conclusion The RFC of the MCA with a cutoff value of 3.4 appeared to be a promising screening tool to exclude cerebral infarction in advance. However, criteria based on change in MFV do not seem useful to predict unfavorable functional outcomes and DCI.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Harst, drs. J.J. van der |
| Faculty: | Medical Sciences |
| Date Deposited: | 16 Dec 2021 13:54 |
| Last Modified: | 16 Dec 2021 13:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2879 |
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