BACKGROUND AND PURPOSE We evaluated optimal transcranial Doppler (TCD) measures for predicting delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). MATERIAL AND METHODS Consecutive patients with aSAH and daily middle cerebral artery (MCA) TCD recordings were retrospectively analyzed. Change in TCD velocity was obtained by creating a smoothing curve. Change in TCD velocity was determined with a linear regression model that confirmed greatest change in velocity associated with DCI occurred at days 2-7. Multivariate logistic regression analysis was then completed. RESULTS 95 patients were evaluated. Increase in TCD velocity at days 2-7 proved to be the best predictor for DCI with an optimal cutoff of 8.9 cm/s/day (p = .019) and AUC 0.651. Multivariate logistic regression analysis using DCI as outcome showed that poor admission Hunt-Hess scores (OR 5.02, 95%CI 1.22-22.67, p = .028) and increases in TCD velocity (OR 5.32, 95%CI 1.41-23.33, p = .018) were independently associated with DCI. CONCLUSIONS We found that relative increases in TCD velocities in the MCAs during the first 7 days (with a threshold increase of 53.4 cm/s from days 2 to 7) after aSAH admission were independently associated with DCI. This association requires independent confirmation.

中文翻译：

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动脉瘤性蛛网膜下腔出血经颅多普勒速度与迟发性脑缺血的关系

背景和目的 我们评估了预测动脉瘤性蛛网膜下腔出血 (aSAH) 后迟发性脑缺血 (DCI) 的最佳经颅多普勒 (TCD) 措施。材料和方法 对连续患有 aSAH 和每日大脑中动脉 (MCA) TCD 记录的患者进行回顾性分析。通过创建平滑曲线获得 TCD 速度的变化。TCD 速度的变化是用线性回归模型确定的，该模型证实了与 DCI 相关的最大速度变化发生在第 2-7 天。然后完成多变量逻辑回归分析。结果 评估了 95 名患者。第 2-7 天 TCD 速度的增加被证明是 DCI 的最佳预测因子，最佳截止值为 8.9 cm/s/天 (p = .019) 和 AUC 0.651。使用 DCI 作为结果的多变量逻辑回归分析显示，入院 Hunt-Hess 评分较差（OR 5.02，95%CI 1.22-22.67，p = .028）和 TCD 速度增加（OR 5.32，95%CI 1.41-23.33，p = .018) 与 DCI 独立相关。结论 我们发现，在 aSAH 入院后的前 7 天内，MCA 中 TCD 速度的相对增加（阈值从第 2 天到第 7 天增加了 53.4 cm/s）与 DCI 独立相关。这种关联需要独立确认。aSAH 入院后第 2 天至第 7 天的 4 cm/s 与 DCI 独立相关。这种关联需要独立确认。aSAH 入院后第 2 天至第 7 天的 4 cm/s 与 DCI 独立相关。这种关联需要独立确认。