Amiliya Kyrylova (München), Prof. Dr. med. Nicole Terpolilli (München), Dr. Christian Brem (München), Prof. Thomas Liebig (München), Prof. Nikolaus Plesnila (München)
Abstract-Text
Background: Aneurysmal subarachnoid hemorrhage (aSAH) may lead to both micro- and macrovascular spasms, resulting in impaired cerebral perfusion and, ultimately, in delayed cerebral ischemia (DCI). While spasm of larger cerebral arteries can be detected by perfusion computed tomography (CTP) or digital subtraction angiography (DSA), perfusion changes of the cerebral microcirculation, which is suggested to be significantly affected after SAH, are not part of routine clinical assessments.
Aim of study: Developing an algorithm to assess and quantify the perfusion of the cerebral microcirculation in datasets obtained from standard 2D-DSA.
Methods: DSA datasets obtained from aSAH patients (n=8; WFNS: 5) and age-matched healthy controls (n=8) admitted to LMU Klinikum from January 1st, 2010, to February 15th, 2023 with a mean age of 54,3 years were analyzed. Time density curves of the contrast agent bolus in ROIs (regions-of-interest) located over the extra- and intracranial segments of the internal carotid artery, the sigmoid sinus in both anterior-posterior (A) and sagittal (B) plane; three ROIs over the M2 branches of the middle cerebral artery and six areas of the cerebral cortex with no visible larger vessels in the B plane vs. two ROIs over the middle cerebral artery as well as two regions-of-interest over the anterior cerebral artery and four peripheral cortex areas in the A plane were analyzed using a custom MATLAB algorithm to calculate peak density, TTP (time-to-peak), rTTP A & rTTP B (relative TTP in A or B plane), AUC (area under the curve), FWHM (full width at half maximum), and MS (maximal slope).
Results: Aneurysms were located at the ICA (n=2), the MCA (n=2), the ACoA (n=2), and in the posterior cerebral circulation (n=2). FWHM and MS were statistically different between the aSAH and the control group.
Conclusion: The currently developed analysis allows to assess microcirculatory flow, i.e. tissue perfusion, using DSA datasets obtained during routine clinical workups. FWHM and MS seem to be promising angiographic markers to quantify cerebral microcirculatory flow following SAH and may thus help to detect microcirculatory dysfunction early after the onset of SAH. Further analyses are ongoing to validate these findings in a large, international multi-center cohort of SAH patients.