Evaluation of Angiographic Delayed Vasospasm due to Ruptured Aneurysm in comparison with Cerebral Circulation Time Measured by IA-DSA Yoshikazu OKADA 1 , Takeshi SHIMA 1 , Masahiro NISHIDA 1 , Kanji YAMANE 1 , Shinji OKITA 1 , Takashi HATAYAMA 1 , Akira YOSHIDA 2 , Yasutaka NAOE 2 , Naoko SHIGA 2 1Department of Neurosurgery, Chugoku Rousai Hospital 2Department of Intensive Care Medicine, Chugoku Rosai Hospital Keyword: SAH , Aneurysm , Vasospasm , IA-DSA , Circulation time pp.439-445
Published Date 1994/5/10
DOI https://doi.org/10.11477/mf.1436900835
  • Abstract
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Delayed vasospasm due to ruptured aneurysm has been basically evaluated by angiographic changes in contrast to clinical features such as delayed ischemic neurological deficits (DIND). However, the discrepan-cies between angiographic and clinical findings have been pointed out, In this study, angiographic changes and cerebral circulation time in ruptured aneurysms were simultaneously investigated with IA-DSA.

Thirty-two patients, who had ruptured aneurysms at the anterior circle of Willis and neck clippings at the acute stage, were investigated. Carotid angiogram was performed with IA-DSA on the 7-13th day after the attack. Angiographic changes were evaluated by Fis-cher's classification and circulation time was calculated in the following way. A time-density curve was obtained at the two ROI's; the C3-C4 portion and the rolandic vein. Circulation time was defined by the dif-ference between the time showing peak optical density at the carotid and the venous portion. The control value of this circulation time obtained from 20 cases with non-rupture aneurysm and epilepsy was 3.4 sec (53 year old) on the avegate. X-ray CT scan examina-tion was performed at the same time and clinical fea-tures were observed everyday.

Angiographically, 3 cases were free from vasospasm, 18 cases were found to present slight to moderate vasospasm, and 11 cases showed severe vasospasm. Circulation time in patients with no spasm was 3.6 seconds, in patients with slight to moderate vasospasm it was 4.3 seconds and in patients with severe vaso-spasm it was 6.8 seconds. Ten patients showing cerebral infarction on CT scans demonstrated significantly long circulation time, 7.0 second on the average. And all pa-tients having severe vasospasm with circulation time more than 6 seconds presented DIND such as hemi-paresis.

Copyright © 1994, Igaku-Shoin Ltd. All rights reserved.


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