Intracranial dynamics biomarkers at traumatic cerebral vasospasm

Alexey O Trofimov; Svetlana Y Trofimova; Darya I Agarkova; Kseniia A Trofimova; Oxana Semyachkina-Glushkovskaya; Dmitriy Atochin; Olga A Bragina; Edwin M Nemoto; Denis E Bragin

doi:10.1016/j.bas.2023.102727

Intracranial dynamics biomarkers at traumatic cerebral vasospasm

Brain Spine. 2023 Dec 12:4:102727. doi: 10.1016/j.bas.2023.102727. eCollection 2024.

Authors

Affiliations

¹ Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
² Department of Biology, Saratov State University, Saratov, Russia.
³ Department of Psychiatry, Boston VA Medical Center West Roxbury, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA, USA.
⁴ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
⁵ Lovelace Biomedical Research Institute, Albuquerque, NM, USA.
⁶ Department of Neurology, University of New Mexico, School of Medicine, Albuquerque, NM, USA.

Abstract

Introduction: Patients who suffer severe traumatic brain injury (sTBI) and cerebral vasospasm (CVS) frequently have posttraumatic cerebral ischemia (PCI).

The research question: was to study changes in cerebral microcirculatory bed parameters in sTBI patients with CVS and with or without PCI.

Material and methods: A total of 136 severe TBI patients were recruited in the study. All patients underwent perfusion computed tomography, intracranial pressure monitoring, and transcranial Doppler. The levels of cerebrovascular resistance (CVR), cerebral arterial compliance (CAC), cerebrovascular time constant (CTC), and critical closing pressure (CCP) were measured using the neuromonitoring complex. Statistical analysis was performed using parametric and nonparametric methods and factor analysis. The patients were dichotomized into PCI-positive (n = 114) and PCI-negative (n = 22) groups. Data are presented as mean values (standard deviations).

Results: CVR was significantly increased, whereas CAC, CTC, and CCP were significantly decreased in sTBI patients with CVS and PCI development (p < 0.05). Factor analyses revealed that all studied microcirculatory bed parameters were significantly associated with the development of PCI (p < 0.05).

Discussion and conclusion: The changes in all studied microcirculatory bed parameters in TBI patients with CVS were significantly associated with PCI development, which enables us to regard them as the biomarkers of CVS and PCI development. The causes of the described microcirculatory bed parameters changes might include complex (cytotoxic and vasogenic) brain edema development, regional microvascular spasm, and dysfunction of pericytes. A further prospective study is warranted.

Keywords: Cerebral vasospasm; Intracranial dynamics biomarkers; TBI.