Association between transcranial Doppler vasospasm and functional outcome after subarachnoid hemorrhage

This study aimed to investigate the association between transcranial Doppler (TCD) vasospasm and patient outcome and to assess the predictive factors for developing TCD vasospasm after subarachnoid hemorrhage (SAH).

This retrospective observational study included adult patients with nontraumatic SAH. Patient characteristics and TCD values were recorded retrospectively from patient records. Data on maxTCD (maximal TCD value recorded on any side between day 1 and day 14) as well as Δ TCD (maximal difference between mean velocity measured on days 1-3 and days 4-14 on any side) were calculated. The modified Rankin Score was recorded from electronic patient notes at discharge and 3, 6, and 12 months after ictus. The effect of TCD vasospasm, maxTCD, and Δ TCD on the clinical outcome was investigated. Potential predictive factors for developing TCD vasospasm were assessed. The association between the same factors and maxTCD and Δ TCD were explored.

One hundred and thirty-eight patients were included in the study. Higher age was associated with a lower risk of developing TCD vasospasm (odds ratio: 0.952, 95% confidence interval: 0.924-0.982, P = 0.002). Fisher grade was a predictor of developing TCD vasospasm (P = 0.05). Age was negatively correlated with maxTCD (R = -0.47, P = 0.01). There was no statistically significant difference in patient outcome at hospital discharge and at 3, 6, and 12 months between patients with and without TCD vasospasm. Higher maxTCD and Δ TCD were associated with a worse clinical outcome at 3 months after SAH ictus.

The clinical benefit of routine TCD assessments in SAH patients remains uncertain.