Published Online
on June 10, 2004

A more recent version of this article appeared on August 1, 2004

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Submitted on March 30, 2004
Revised on April 30, 2004
Accepted on May 6, 2004

Basilar Artery Vasospasm and Delayed Posterior Circulation Ischemia After Aneurysmal Subarachnoid Hemorrhage

Gill E. Sviri MD, MSc^*; David H. Lewis MD; Reinaldo Correa RN; Gavin W. Britz MD, MPH; Colleen M. Douville RN; and David W. Newell MD

From the Departments of Neurological Surgery (G.E.S., R.C., G.W.B., C.M.D., D.W.N.) and Radiology (D.H.L.), Harborview Medical Center, University of Washington, Seattle, Washington.

^* To whom correspondence should be addressed. E-mail: sviri{at}u.washington.edu.

Purpose--The clinical and hemodynamic impacts of basilar artery (BA) vasospasm (VS) after aneurysmal subarachnoid hemorrhage (SAH) are ill-defined. The purpose of the present study was to evaluate the relationship between BA-VS and regional cerebral blood flow (rCBF) with posterior circulation after aneurysmal SAH.

Methods--Daily transcranial Doppler (TCD) measurements of posterior and anterior circulation arteries were conducted in 162 patients with aneurysmal SAH. rCBF to the brain stem (BS) and other brain territories was assessed by multiple single-photon emission computed tomography with ^99mTc ethyl cysteinate dimer single-photon emission computed tomography (ECD-SPECT) imaging during the course of VS.

Results--SPECT imaging showed delayed BS hypoperfusion in 29 patients (17.9%). Of them, 23 patients (79.3%) were found to have BA-VS. Patients with very high BA flow velocities (FVs; >115 cm/s) had a 50% chance of developing delayed BS ischemia. BA-VS was found at a higher rate in patients who experienced reduced rCBF in the cerebellum (56.3%), thalamic nuclei (68.4%), and occipital lobe (81.8%). Although patients with delayed BS hypoperfusion did not present with a higher clinical grade, their clinical outcome was significantly worse (Glasgow Outcome Score after 30 days 2.48±1.16 versus 3.3±1.27; P=0.001).

Conclusions--These findings suggest for the first time that BA-VS after aneurysmal SAH is associated with hypoperfusion to BS and other posterior circulation territories. The risk for delayed BS ischemia increased significantly when TCD BA-FVs were >115 cm/s.

Key words: basilar artery • vasospasm • cerebral blood flow • tomography, emission computed • ultrasonography, Doppler, transcranial • subarachnoid hemorrhage • brain stem • ischemia

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