Impairment of Cerebral Autoregulation Predicts Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Prospective Observational Study

Authors: Budohoski KP, Czosnyka M, Smielewski P, Kasprowicz M, Helmy A, Bulters D, Pickard JD, Kirkpatrick PJ.

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a recognized contributor to unfavorable outcome after subarachnoid hemorrhage (SAH). Recent data challenge the concept of vasospasm as the sole cause of ischemia and suggest a multifactorial process with dysfunctional cerebral autoregulation as a component. We tested the hypothesis that early autoregulatory failure, detected using near-infrared spectroscopy-based index, TOxa and transcranial Doppler-based index, Sxa, can predict DCI.
METHODS: In this prospective observational study we enrolled consecutive patients with aneurysmal SAH that occurred <5 days from admission. The primary end point was the occurrence of DCI within 21 days of ictus. The predictive value of autoregulatory disturbances detected in the first 5 days was assessed using univarate proportional hazards model and a multivariate model.
RESULTS: Ninety-eight patients were included. Univariate analysis demonstrated increased odds of developing DCI when early autoregulation failure was detected (odds ratio [OR], 7.46; 95% confidence interval [CI], 3.03-18.40 and OR, 4.52; 95% CI, 1.84-11.07 for Sxa and TOxa, respectively) but not TCD-vasospasm (OR, 1.36; 95% CI, 0.56-3.33). In a multivariate model Sxa and TOxa remained independent predictors of DCI (OR, 12.66; 95% CI, 2.97-54.07 and OR, 5.34; 95% CI, 1.25-22.84 for Sxa and TOxa, respectively).
CONCLUSIONS: Disturbed autoregulation in the first 5 days after SAH significantly increases the risk of DCI. Autoregulatory disturbances can be detected using near-infrared spectroscopy and transcranial Doppler technologies.

Full text and source: Stroke

Stroke. 2012 Nov 13. [Epub ahead of print]