Transcranial Doppler velocity and associations with delayed cerebral ischemia in aneurysmal subarachnoid Hemorrhage

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. •Pathophysiology leading to delayed cerebral ischemia remains unclear•Role of transcranial Doppler in subarachnoid hemorrhage management remains unclear•Early increases in TCD velocity may be a predictor for delayed cerebral ischemia•An 8.9 cm/s/day increase in MCA velocity from days 2–7 was associated with DCI