An additional consideration to the angiographic evaluation of vasospasm is the potential for intra-arterial treatment of vessel narrowing. However, intra-arterial treatment of vasospasm lacks high-quality evidence of improvement of outcomes at this time [6]. CT Head SAH on CT head can be graded by the Fisher or modified Fisher scale. The higher the Fisher grade of SAH, the higher the patient risk for vasospasm [35]. Although CT head may be useful to provide a Fisher grade and risk for vasospasm, the examination does not directly give information regarding the presence or absence of vasospasm. Anatomic changes of completed infarct related to delayed cerebral ischemia can also be identified on CT head. CTA Head CTA head can provide a less invasive evaluation of the intracranial cerebral vasculature compared with catheter- directed angiography. In a meta-analysis, CTA head detected vasospasm with a sensitivity and specificity of 80% and 93%, respectively [33]. CTA head is highly correlated to conventional angiography for larger proximal intracranial vessels with decreasing correlation in the smaller more distal arteries [36]. CTA Neck There is no relevant literature to support the use of CTA neck in the evaluation of suspected cerebral vasospasm. CTV Head There is no relevant literature to support the use of CTV head in the evaluation of suspected cerebral vasospasm. MRA Head There is no relevant literature to support the use of MRA head in the evaluation of suspected cerebral vasospasm. MRA head evaluation of the intracranial arteries in the setting of suspected vasospasm is limited by background of hemorrhage and hemodynamic flow alterations with poor correlation to digital subtraction angiography (DSA) findings [37]. MRA Neck There is no relevant literature to support the use of MRA neck in the evaluation of suspected cerebral vasospasm.
Cerebrovascular Diseases Aneurysm Vascular Malformation and Subarachnoid Hemorrhage PCAs. An additional consideration to the angiographic evaluation of vasospasm is the potential for intra-arterial treatment of vessel narrowing. However, intra-arterial treatment of vasospasm lacks high-quality evidence of improvement of outcomes at this time [6]. CT Head SAH on CT head can be graded by the Fisher or modified Fisher scale. The higher the Fisher grade of SAH, the higher the patient risk for vasospasm [35]. Although CT head may be useful to provide a Fisher grade and risk for vasospasm, the examination does not directly give information regarding the presence or absence of vasospasm. Anatomic changes of completed infarct related to delayed cerebral ischemia can also be identified on CT head. CTA Head CTA head can provide a less invasive evaluation of the intracranial cerebral vasculature compared with catheter- directed angiography. In a meta-analysis, CTA head detected vasospasm with a sensitivity and specificity of 80% and 93%, respectively [33]. CTA head is highly correlated to conventional angiography for larger proximal intracranial vessels with decreasing correlation in the smaller more distal arteries [36]. CTA Neck There is no relevant literature to support the use of CTA neck in the evaluation of suspected cerebral vasospasm. CTV Head There is no relevant literature to support the use of CTV head in the evaluation of suspected cerebral vasospasm. MRA Head There is no relevant literature to support the use of MRA head in the evaluation of suspected cerebral vasospasm. MRA head evaluation of the intracranial arteries in the setting of suspected vasospasm is limited by background of hemorrhage and hemodynamic flow alterations with poor correlation to digital subtraction angiography (DSA) findings [37]. MRA Neck There is no relevant literature to support the use of MRA neck in the evaluation of suspected cerebral vasospasm.