Utility of real-time angiographic perfusion imaging in endovascular treatment of cerebral vasospasm.

Abstract

Introduction: Angiographic perfusion imaging derived from digital subtraction angiography (DSA) is not routinely utilized for patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage. We investigate the utility of this technique for endovascular vasospasm treatment procedures. Method(s): Real-time blood flow analysis was performed using parametric colour coding on pre- and post-intervention DSA. Semi-quantitative parenchymal perfusion parameters [arrival time (AT) of contrast, time to peak (TTP) opacification and mean transit time (MTT) of contrast] were calculated across 3 vascular territories [anterior cerebral artery (ACA), middle cerebral artery (MCA) and Lenticulostriate (LtA)] using standard 2-dimensional angiographic perfusion software. The pre and post intervention arterial vessel diameters were measured on all included studies. A student's paired t-test was used to assess for statistically significant differences between pre and post treatment values. Result(s): Twelve endovascular vasospasm treatment episodes in 6 patients were included. All patients received intra-arterial vasodilator therapy. Following endovascular treatment, parenchymal flow analysis showed improvement in TTP and MTT across all vascular territories (p<0.002) and improvement in AT in the ACA and MCA territories (p<0.03). Improvement in parenchymal perfusion parameters correlated with improvement in vessel diameters in all territories following treatment (p<0.05). Conclusion(s): Real-time parenchymal perfusion imaging during endovascular vasospasm treatment procedures is feasible and provides reliable semiquantitative measurement of angiographic treatment response.