Role of transcranial doppler in neuroradiological treatment of intracranial vasospasm

Background and Purpose: The expanded role of interventional neuroradiological treatment for postsubarachnoid hemorrhage vasospasm has highlighted the diagnostic utility of transcranial Doppler studies in this condition. The role of transcranial Doppler in follow-up and determining the need for repeat intervention has not been previously emphasized. Summary of Report: Intracranial angioplasty for clinically evident vasospasm after subarachnoid hemorrhage was performed in four patients. In two patients, transcranial Doppler flow velocities remained elevated despite initial anatomic correction of the vasospasm. Reangiography revealed new areas of involvement by vasospasm. Reangioplasty or papaverine infusion treatment of the new lesions resulted in decreased flow velocities and clinical improvement in all patients. Conclusions: Transcranial Doppler has a more significant role than has been previously emphasized in the management of patients undergoing interventional neuroradiological treatment for intracranial vasospasm. Specifically, the persistence of elevated transcranial Doppler flow velocities after intracranial angioplasty suggests the need for repeat angiographic evaluation and possibly further therapy.