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The Utility of Ankle-Brachial Index as a Predictor of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage.
World Neurosurg. 2016 May; 89:139-46.WN

Abstract

OBJECTIVE

Delayed cerebral ischemia (DCI) can cause significant morbidity and mortality in patients suffering from aneurysmal subarachnoid hemorrhage (SAH). Because arterial stiffness has been correlated with vascular risk factors, we evaluated whether the ankle-brachial index (ABI), the ratio of the ankle and brachial systolic blood pressures, can predict DCI.

METHODS

In a prospective cohort study, we measured the ABIs of 24 patients with aneurysmal SAH during the weeks after SAH. Angiographic vasospasm was evaluated via diagnostic cerebral angiograms. Transcranial Doppler (TCD) was used to assess associations among ABI, DCI, and angiographic vasospasm.

RESULTS

Patients were evaluated on the basis of the presence or absence of DCI (days 3-14 after SAH). Demographic and history factors were similar between the DCI and non-DCI groups. Patients in the DCI group had a greater modified Fisher grade (P = 0.029) and were more likely to have been treated via clipping (P = 0.032) and to demonstrate angiographic vasospasm (P = 0.009). Mean TCD values in the 2 groups were significantly different after day 5 in varied arterial distributions (P < 0.05). ABI values in the DCI group were significantly lower on posthemorrhage days 2-13 and when averaged over the 2-week study period (P < 0.05). An average ABI >1.045 on days 2-7 was 85% sensitive and 82% specific for predicting absence of DCI.

CONCLUSIONS

In this small single-center study, lower ABI values were strongly associated with SAH-induced DCI, which may provide a tool for managing DCI in aneurysmal SAH.

Authors+Show Affiliations

Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26828462

Citation

Guan, Jian, et al. "The Utility of Ankle-Brachial Index as a Predictor of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage." World Neurosurgery, vol. 89, 2016, pp. 139-46.
Guan J, Karsy M, Brock A, et al. The Utility of Ankle-Brachial Index as a Predictor of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2016;89:139-46.
Guan, J., Karsy, M., Brock, A., & Couldwell, W. T. (2016). The Utility of Ankle-Brachial Index as a Predictor of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage. World Neurosurgery, 89, 139-46. https://doi.org/10.1016/j.wneu.2016.01.048
Guan J, et al. The Utility of Ankle-Brachial Index as a Predictor of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2016;89:139-46. PubMed PMID: 26828462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Utility of Ankle-Brachial Index as a Predictor of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage. AU - Guan,Jian, AU - Karsy,Michael, AU - Brock,Andrea, AU - Couldwell,William T, Y1 - 2016/01/30/ PY - 2015/12/17/received PY - 2016/01/22/revised PY - 2016/01/23/accepted PY - 2016/2/2/entrez PY - 2016/2/2/pubmed PY - 2017/5/23/medline KW - Ankle-brachial index KW - Arterial stiffness KW - Cerebral aneurysm KW - Delayed cerebral ischemia KW - Subarachnoid hemorrhage KW - Vasospasm SP - 139 EP - 46 JF - World neurosurgery JO - World Neurosurg VL - 89 N2 - OBJECTIVE: Delayed cerebral ischemia (DCI) can cause significant morbidity and mortality in patients suffering from aneurysmal subarachnoid hemorrhage (SAH). Because arterial stiffness has been correlated with vascular risk factors, we evaluated whether the ankle-brachial index (ABI), the ratio of the ankle and brachial systolic blood pressures, can predict DCI. METHODS: In a prospective cohort study, we measured the ABIs of 24 patients with aneurysmal SAH during the weeks after SAH. Angiographic vasospasm was evaluated via diagnostic cerebral angiograms. Transcranial Doppler (TCD) was used to assess associations among ABI, DCI, and angiographic vasospasm. RESULTS: Patients were evaluated on the basis of the presence or absence of DCI (days 3-14 after SAH). Demographic and history factors were similar between the DCI and non-DCI groups. Patients in the DCI group had a greater modified Fisher grade (P = 0.029) and were more likely to have been treated via clipping (P = 0.032) and to demonstrate angiographic vasospasm (P = 0.009). Mean TCD values in the 2 groups were significantly different after day 5 in varied arterial distributions (P < 0.05). ABI values in the DCI group were significantly lower on posthemorrhage days 2-13 and when averaged over the 2-week study period (P < 0.05). An average ABI >1.045 on days 2-7 was 85% sensitive and 82% specific for predicting absence of DCI. CONCLUSIONS: In this small single-center study, lower ABI values were strongly associated with SAH-induced DCI, which may provide a tool for managing DCI in aneurysmal SAH. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/26828462/The_Utility_of_Ankle_Brachial_Index_as_a_Predictor_of_Delayed_Cerebral_Ischemia_in_Aneurysmal_Subarachnoid_Hemorrhage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(16)00134-0 DB - PRIME DP - Unbound Medicine ER -