cerebrovascular reactivity Archives

Marianne Lundervik Bøthun has shown that ultrasound is useful to assess risk in patients with intracranial aneurysms.

MAIN RESULTS:

Carotid intima-media thickness can be a predictor of intracranial aneurysm rupture.
Cerebrovascular reactivity is not systematically impaired in patients with unruptured intracranial aneurysms.
Prediction models including cerebrovacular reactivity could identify patients at risk of delayed cerebral ischemia following subarachnoid hemmorhage.

THESIS DEFENCE:

Thesis: Carotid intima-media thickness and cerebrovascular vasoreactivity in patients with intracranial aneurysms
Candidate: Marianne Lundervik Bøthun
Time: April 3, 2020 at 12:15
Place: Online-based solution, due to the covid-19 situation
Link to university website (in Norwegian)

SUMMARY:

(1) Carotid intima-media thickness associates with intracranial aneurysm rupture. Generally, patients with aneurysmal subarachnoid hemmorhage have more pronounced carotid atherosclerosis than healthy persons.

Carotid ultrasound was performed to quantify subclinical atherosclerosis in 28 patients with unruptured intracranial aneurysms, 41 patients with subarachnoid hemmorhage following aneurysm rupture, and 80 healthy controls. Intima media-thickness was higher in the group with subarachnoid hemmorhage. It was also the only variable that independently predicted subarachnoid hemmorhage compared to having unruptured intracranial aneurysms, with a 62 % inceased risk for each 0.10 mm increment.

(2) Patients with unruptured intracranial aneurysms have cerebrovascular reactivity within the normal range of healthy persons. The study examines cerebrovascular reactivity in 37 patients the first week after treatment for unruptured aneurysms, using transcranial Doppler monitoring to measure blood flow velocities.

(3) One year later, blood velocities had decreased bilaterally. However, the cerebrovascular reactivity had only increased on the ipsilateral side of treatment, not on the contralateral side. Larger intracranial aneurysms were linked to higher change.

(4) Impaired cerebrovascular reactivity could independently predict delayed cerebrovascular ischemia following subarachnoid hemmorhage. Bøthun has constructed an improved prediction model to identify patients at increased risk of delayed cerebrovascular ischemia. The model including cerebrovascular reactivity performed better than a model using previously established predictors.

42 patients with aneurysmal subarachnoid hemmorhage and 37 patients treated for unruptured aneurysms participated in the study. Patients who deterioritated clinically due to delayed cerebral ischemia had lower cerebrovascular reactivity than patients without ischemia.

REFERENCES:

(1) Lundervik, M., Fromm, A., Haaland, Ø. A., Waje-Andreassen, U., Svendsen, F., Thomassen, L., & Helland, C. A. (2014). Carotid intima-media thickness–a potential predictor for rupture risk of intracranial aneurysms. International Journal of Stroke, 9(7), 866-872.

(2) Bøthun, M. L., Haaland, Ø. A., Logallo, N., Svendsen, F., Thomassen, L., & Helland, C. A. (2016). Cerebrovascular reactivity after treatment of unruptured intracranial aneurysms—A transcranial Doppler sonography and acetazolamide study. Journal of the neurological sciences, 363, 97-103.

(3) Bøthun, M. L., Haaland, Ø. A., Logallo, N., Svendsen, F., Thomassen, L., & Helland, C. A. (2018). Time course of cerebrovascular reactivity in patients treated for unruptured intracranial aneurysms: a one-year transcranial doppler and acetazolamide follow-up study. BioMed research international, 2018.

(4) Bøthun, M. L., Haaland, Ø. A., Moen, G., Logallo, N., Svendsen, F., Thomassen, L., & Helland, C. A. (2019). Impaired cerebrovascular reactivity may predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Journal of the neurological sciences, 407, 116539.

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