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Será o Eco doppler transcraniano uma possível ferramenta de diagnóstico de vasoespasmo cerebral? Revisão sistemática
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Abstract(s)
Introdução: A hemorragia subaracnoide (HSA) é uma condição neurológica
crítica, frequentemente associada a elevadas taxas de mortalidade e morbilidade.
Uma das complicações mais graves associadas à HSA é o vasoespasmo cerebral
(VEC), que é uma condição clínica grave secundária à isquemia cerebral. A
angiografia por subtração digital (ASD) é o gold-standard no diagnóstico do VEC,
mas a sua natureza invasiva limita a sua utilização recorrente, o que implica um
aumento da necessidade de métodos alternativos. Neste sentido, o Doppler
Transcraniano (DTC) emerge como meio não invasivo para a monitorização
contínua e precoce do VEC.
Objetivo: Avaliar a eficácia do Doppler transcraniano como ferramenta de
diagnóstico precoce e não invasiva do VEC em pacientes com HSA.
Metodologia: A pesquisa foi realizada nas bases de dados MEDLINE/PubMed,
Web of Science e Scopus, incluindo estudos observacionais publicados entre
janeiro de 2013 e agosto de 2024, em inglês. As palavras-chave utilizadas foram:
("adult patients" OR "subarachnoid hemorrhage") AND “transcranial Doppler"
AND ("cerebral vasospasm" OR "vasospasm diagnosis"). A seleção e análise dos
estudos foi realizada de forma independente por três revisores. A análise de viés
dos estudos incluídos foi avaliada utilizando a escala Newcastle-Ottawa (NOS),
que analisa três domínios principais: seleção, comparabilidade e desfechos. Os
principais outcomes analisados incluíram a sensibilidade e especificidade do DTC
na deteção precoce do VEC, assim como a sua aplicação clínica na monitorização
contínua dos pacientes com HSA. Foram também considerados os benefícios da
sua utilização como alternativa não invasiva em comparação com os métodos
tradicionais.
Resultados: Os seis estudos observacionais incluídos evidenciaram que o DTC
apresenta uma sensibilidade moderada a alta na deteção de VEC, especialmente
quando utilizado em conjunto com outros meios diagnósticos. Já no que diz
respeito à sua especificidade, esta é mais variável, representando a técnica e
experiência do operador um papel de impacto major nesta característica. Os estudos mostraram que o DTC é de especial utilidade para a monitorização
contínua à cabeceira do paciente, oferecendo a vantagem de ser uma técnica não
invasiva e em tempo real, embora continue a haver limitações em termos de
precisão quando comparada à ASD.
Conclusão: O DTC é uma alternativa promissora e viável para a deteção precoce
e monitorização do VEC em pacientes com HSA, particularmente devido à sua
natureza não invasiva e à capacidade de monitorizar alterações hemodinâmicas
cerebrais de forma contínua. No entanto, a variação na sensibilidade e
especificidade observada nos estudos analisados, ressalta a necessidade de mais
pesquisas que explorem a padronização da técnica, bem como demonstra o
impacto da formação profissional na execução desta técnica. Para estudos futuros
recomenda-se o foco na otimização de protocolos de uso do DTC, com o objetivo
de maximizar sua aplicabilidade clínica e melhorar os outcomes em pacientes
com HSA.
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological condition often associated with high rates of mortality and morbidity. One of the most severe complications associated with SAH is cerebral vasospasm (CV), resulting from clinical deterioration secondary to cerebral ischemia. Digital subtraction angiography (DSA) is the gold standard in diagnosing CV, but its invasive nature limits the repeated use, increasing the need for alternative methods. Transcranial Doppler (TCD) emerges as a non-invasive means for the continuous and early monitoring of CV. Objective: To evaluate the efficacy of Transcranial Doppler (TCD) as a noninvasive and early diagnostic tool for CV in patients with SAH. Methodology: The research was conducted using the databases MEDLINE/PubMed, Web of Science, and Scopus, including observational studies published between January 2013 and August 2024, in English. The keywords used were: ("adult patients" OR "subarachnoid hemorrhage") AND "transcranial Doppler" AND ("cerebral vasospasm" OR "vasospasm diagnosis"). The selection and analysis of the studies were performed independently by three reviewers. The risk of bias in the included studies was assessed using the Newcastle-Ottawa Scale (NOS), which analyzes three main domains: selection, comparability, and outcomes. The main outcomes analyzed included the sensitivity and specificity of TCD in the early detection of CV, as well as its clinical application in the continuous monitoring of patients with SAH. The benefits of its use as a non-invasive alternative compared to traditional methods were also considered. Results: The six included observational studies indicated that TCD has moderate to high sensitivity in detecting CV, especially when used in conjunction with other diagnostic methods. However, its specificity varies depending on the technique and operator experience. TCD proved useful for continuous bedside monitoring, offering the advantage of being a non-invasive and real-time technique, although limitations in terms of precision compared to DSA still exist. Conclusion: TCD is a promising and viable alternative for the early detection and monitoring of CV in patients with SAH, particularly due to its non-invasive nature and ability to continuously monitor cerebral hemodynamic changes. However, the variation in sensitivity and specificity observed in the analyzed studies highlights the need for further research exploring the standardization of the technique and the impact of professional training on result interpretation. For future studies, we recommend focusing on optimizing TCD usage protocols to maximize its clinical applicability and improve outcomes in patients with SAH.
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological condition often associated with high rates of mortality and morbidity. One of the most severe complications associated with SAH is cerebral vasospasm (CV), resulting from clinical deterioration secondary to cerebral ischemia. Digital subtraction angiography (DSA) is the gold standard in diagnosing CV, but its invasive nature limits the repeated use, increasing the need for alternative methods. Transcranial Doppler (TCD) emerges as a non-invasive means for the continuous and early monitoring of CV. Objective: To evaluate the efficacy of Transcranial Doppler (TCD) as a noninvasive and early diagnostic tool for CV in patients with SAH. Methodology: The research was conducted using the databases MEDLINE/PubMed, Web of Science, and Scopus, including observational studies published between January 2013 and August 2024, in English. The keywords used were: ("adult patients" OR "subarachnoid hemorrhage") AND "transcranial Doppler" AND ("cerebral vasospasm" OR "vasospasm diagnosis"). The selection and analysis of the studies were performed independently by three reviewers. The risk of bias in the included studies was assessed using the Newcastle-Ottawa Scale (NOS), which analyzes three main domains: selection, comparability, and outcomes. The main outcomes analyzed included the sensitivity and specificity of TCD in the early detection of CV, as well as its clinical application in the continuous monitoring of patients with SAH. The benefits of its use as a non-invasive alternative compared to traditional methods were also considered. Results: The six included observational studies indicated that TCD has moderate to high sensitivity in detecting CV, especially when used in conjunction with other diagnostic methods. However, its specificity varies depending on the technique and operator experience. TCD proved useful for continuous bedside monitoring, offering the advantage of being a non-invasive and real-time technique, although limitations in terms of precision compared to DSA still exist. Conclusion: TCD is a promising and viable alternative for the early detection and monitoring of CV in patients with SAH, particularly due to its non-invasive nature and ability to continuously monitor cerebral hemodynamic changes. However, the variation in sensitivity and specificity observed in the analyzed studies highlights the need for further research exploring the standardization of the technique and the impact of professional training on result interpretation. For future studies, we recommend focusing on optimizing TCD usage protocols to maximize its clinical applicability and improve outcomes in patients with SAH.
Description
Keywords
Diagnóstico Doppler Transcraniano Hemorragia Subaracnoidea Vasoespasmo Cerebral