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Selective 4 Vessels Angiography in Brain Death: A Retrospective Study

Published online by Cambridge University Press:  02 December 2014

Martin Savard ,
Alexis F. Turgeon ,
Jean-Luc Gariépy ,
François Trottier  and
Stephan Langevin
Martin Savard*
Affiliation:
Département des Sciences Neurologiques, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Québec, Canada
Alexis F. Turgeon
Affiliation:
Département d'Anesthésiologie, Service de Soins Intensifs, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Québec, Canada Unité de Recherche en Traumatologie - Urgence - Soins Intensifs, Centre de Recherche du CHA, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Québec, Canada
Jean-Luc Gariépy
Affiliation:
Département de Radiologie, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Québec, Canada
François Trottier
Affiliation:
Département de Radiologie, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Québec, Canada
Stephan Langevin
Affiliation:
Département d'Anesthésiologie, Service de Soins Intensifs, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Québec, Canada
*
Département des Sciences Neurologiques, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, 1401 18e rue, Québec, Québec, G1J 1Z4, Canada.
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Abstract

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Background:

In Canada, ancillary tests, such as selective four vessels angiography (S4VA), are sometimes necessary for brain death (BD) diagnosis when the clinical exam cannot be completed or confounding factors are present. Recent Canadian guidelines assert that brain death is supported by the absence of arterial blood flow at the surface of the brain and that venous return should not be considered. However, neuropathologic and angiographic studies have suggested that arteries might still be patent in BD patients. Current clinical practices in BD diagnosis following S4VA need to be better understood.

Methods:

We conducted a retrospective study of all S4VA performed for the determination of BD in a level 1 NeuroTrauma centre from 2003 to 2007. The objective of the study was to describe the prevalence of intracranial arterial, capillary (parenchymogram) and venous opacification in our study population. All tests were reviewed independently by two neuroradiologists. Disagreements were resolved by consensus.

Results:

Thirty two patients were declared BD following S4VA during the study period. Nine of these patients (28%) presented some proximal opacification of intracranial arteries (95% CI 15-45%). As opposed, none had a cerebral capillary and deep venous drainage opacification (95% CI 0-10%).

Conclusion:

The absence of cerebral deep venous drainage or parenchymogram might represent a better objective marker of cerebral circulatory arrest for brain death diagnosis when the use of S4VA is required. These findings open the path for further research in enhancing our interpretation of angiographic studies for brain death diagnosis.

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 4 , July 2010 , pp. 492 - 497
Copyright
Copyright © The Canadian Journal of Neurological 2010

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