Ultrasound Perfusion Imaging After Aneurysmal Subarachnoid Hemorrhage

Study Overview
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Brief Summary
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The purpose of this study is to examine wether delayed cerebral ischemia can be predicted by ultrasound brain perfusion imaging in patients with aneurysmal subarachnoid hemorrhage (SAH).

Detailed Description
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The delayed cerebral ischemia is a main complication in patient with aneurysmal subarachnoid hemorrhage which causes neurological deficit. So far there is no reliable diagnostic tool to predict the appearance of cerebral ischemia. The causal correlation between presence of cerebral vasospasm measured daily by transcranial Doppler sonography (TCD) and occurrence of cerebral ischemia detected by cranial computed tomography scan (CCT) is not finally verified. First studies demonstrated that ultrasound perfusion imaging (UPI) allows the detection of perfusion deficits in middle cerebral artery infarction. The purpose of our study is to evaluate the diagnostic and prognostic value of UPI to predict delayed cerebral ischemia. In our trial we compare parameters of UPI (b= rise rate, A= plateau of acoustic intensity) in patients with aneurysmal subarachnoid hemorrhage with results of follow-up cranial computed tomography scans (CCT), TCD results and clinical outcome.

Official Title
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Ultrasound Perfusion Imaging After Aneurysmal Subarachnoid Hemorrhage

Conditions
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Aneurysmal Subarachnoid Hemorrhage

Intervention / Treatment
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* Device: Ultrasound Perfusion Imaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aneurysmal subarachnoid hemorrhage, Hunt and Hess 0-5 Informed consent Sufficient transtemporal acoustic window First examination within 48h after subarachnoid hemorrhage Minimum Age 18 years Exclusion Criteria: Contraindication against computed tomographic scan Incompatibility against SonoVue™ Acute respiratory distress syndrome Uncontrollable hypertensive crisis Severe pulmonary disease(pulmonary hypertension > 90 mmHg) acute severe cardiac insufficiency (New York Heart Association IV) known right-left-shunt pregnancy and breastfeeding Substance dependence

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ultrasound Perfusion Imaging<br>Patient with subarachnoid hemorrhage. | Device: Ultrasound Perfusion Imaging<br>* Sonographic unit Phillips IU 22, 5ml SonoVue ultrasound contrast agent per examination, Duration: 1h<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of perfusion | Detection of hypoperfusion (defined by 50% or more reduction in beta-value of comparing day 1. with day 5.) in one or more of four regions in one or both hemispheres before the detection of delayed ischemia after SAH in CCT. | Baseline, Day 5 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between perfusion parameters, clinical course and flow velocities | Correlation between perfusion parameters (beta- and A-value), clinical course (National Institute of Health Stroke Scale - NIHSS) and flow velocities in the middle and posterior cerebral artery from day 1 to day 90. | Day 1 to 90 | 
| Change of Perfusion | Detection of hypoperfusion (defined by 50% or more reduction in A-value of comparing day 1. with day 5.) in one or more of four regions in one or both hemispheres before the detection of delayed ischemia after SAH in CCT. | Baseline, Day 5 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Aneurysmal Subarachnoid Hemorrhage, SAB, SAH, Ultrasound, Perfusion imaging