Morphological changes of intracranial pressure quantifies vasodilatory effect of verapamil to treat cerebral vasospasm.
Morphological changes of intracranial pressure quantifies vasodilatory effect of verapamil to treat cerebral vasospasm.
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颅内压的形态变化量化了维拉帕米治疗脑血管痉挛的血管舒张作用。
DOI：
10.1136/neurintsurg-2019-015499
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发表时间：
2020-08
影响因子：
4.8
通讯作者：
Hu X
中科院分区：
文献类型：
--
作者：
Liu X;Vitt JR;Hetts SW;Gudelunas K;Ho N;Ko N;Hu X
蛛网膜下腔出血SAH后，近端和远端脑血管痉挛均可导致迟发性脑缺血。动脉内（IA）血管扩张剂是治疗远端动脉血管痉挛的主要方法，但目前还没有成熟的方法来评估实时干预的有效性。本研究旨在介绍一种新的方法，用于脑血管痉挛血管内治疗（EVT）的连续术中评估。我们的方法的前提是，远端脑动脉的变化引起颅内压（ICP）脉冲的形态学变化的一致模式。这一前提是证明使用发表的算法在以前的论文。在这项研究中，我们应用该算法来计算脑血管舒张（CABG）和脑血管收缩（VCI）的可能性，从术中ICP信号，与注射IA血管扩张剂维拉帕米同步。观察IA治疗前后双侧脑动脉血流速度（CBFV）的变化。对192例SAH患者的记录进行了审查，其中27例记录具有高质量的ICP波形。首次注射维拉帕米后的VCI（0.47 ± 0.017）显著低于基线时的VCI（0.49 ± 0.020，p<0.001）。维拉帕米注射液剂量越大，增加幅度越大，持续时间越长。大脑中动脉（MCA）的CBFV在注射维拉帕米前几天增加，IA治疗后下降。本研究提供了一种算法的初步验证，用于连续评估血管痉挛和蛛网膜下腔出血患者对IA血管扩张剂输注的远端脑动脉变化。
After aneurysmal subarachnoid hemorrhage SAH, both proximal and distal cerebral vasospasm can contribute to the development of delayed cerebral ischemia. Intra-arterial (IA) vasodilators are a mainstay of treatment for distal arterial vasospasm, however there are no well-established methods to assess the efficacy of interventions in real-time. This study aims to introduce a new method for continuous intra-procedural assessment of endovascular treatment (EVT) for cerebral vasospasm. The premise of our approach is that distal cerebral arterial changes induce a consistent pattern in the morphological changes of intracranial pressure (ICP) pulse. This premise was demonstrated using a published algorithm in previous papers. In this study, we applied the algorithm to calculate the likelihood of cerebral vasodilation (VDI) and cerebral vasoconstriction (VCI) from intra-procedural ICP signals that are synchronized with injection of IA vasodilator verapamil. Cerebral blood flow velocities (CBFV) on bilateral cerebral arteries were studied pre and post IA therapy. 192 recordings of SAH patients were reviewed and 27 recordings have high-quality ICP waveforms. The VCI was significantly lower after the first verapamil injection (0.47 ± 0.017) than VCI at baseline (0.49 ± 0.020, p<0.001). Larger dosage of verapamil injection results in larger and longer VDI increase. CBFV of middle cerebral artery (MCA) increases across days before the injection of verapamil and it decreases after IA therapy. This study provides preliminary validation of an algorithm for continuous assessment of distal cerebral arterial changes in response to IA vasodilator infusion in patients with vasospasm and aneurysmal SAH.
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DOI：
10.1109/tbme.2008.2008636
发表时间：
2009-03
期刊：
IEEE transactions on bio-medical engineering
影响因子：
--
作者：
Hu X;Xu P;Scalzo F;Vespa P;Bergsneider M
通讯作者：
Bergsneider M
影响因子：
3.7
作者：
Daftari Besheli L;Tan CO;Bell DL;Hirsch JA;Gupta R
通讯作者：
Gupta R
影响因子：
3.5
作者：
Asgari, Shadnaz;Bergsneider, Marvin;Hamilton, Robert;Vespa, Paul;Hu, Xiao
通讯作者：
Hu, Xiao
影响因子：
3.2
作者：
Asgari S;Vespa P;Bergsneider M;Hu X
通讯作者：
Hu X
影响因子：
3.5
作者：
Liu, Xiuyun;Zimmermann, Lara L.;Hu, Xiao
通讯作者：
Hu, Xiao