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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Can induced hypertension ameliorate perfusion deficits and prevent infarction in patients with aneurysmal subarachnoid haemorrhage?

Kann die induzierte Hypertension Perfusionsdefizite verbessern und Infarkte vermeiden bei Patienten mit aneurysmatischer Subarachnoidalblutung?

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  • presenting/speaker Silvia Hernández-Durán - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Bogdan Iliev - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland; Westpfalz Klinikum, Klinik für Neurochirurgie, Kaiserslautern, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Vesna Malinova - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV140

doi: 10.3205/19dgnc155, urn:nbn:de:0183-19dgnc1552

Published: May 8, 2019

© 2019 Hernández-Durán et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Induced hypertension (IH) is the last bastion remaining of the previously employed “Triple-H” therapy in the management of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, IH has failed to prove a beneficial effect in controlled trials, and its use is only supported by small, uncontrolled studies. The goal of this study was to determine if IT has an effect on cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) measured with computed tomography perfusion (CTP) and the incidence of infarction.

Methods: We conducted a retrospective study of patients with aSAH admitted to our center between 2013 and 2016. Inclusion criteria were (a) IH for treatment of vasospasm, as determined in transcranial doppler ultrasonography; (b) computed tomography perfusion (CTP) performed immediately before initiation of IH; (c) CTP conducted after IH establishment. Patients who underwent interventional treatment, such as balloon dilatation or pharmacological lysis with intraarterial nimodipine, were excluded. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were analyzed in the CTP before and after IH initiation, and the incidence of infarctions was recorded.

Results: A total of 96 patients with CTP before initiation of IH were screened. Of these, 33 fulfilled the inclusion criteria. A total of n=18 patients exhibited CBF and MTT deficits in the pre-IH CTP, while n=17 showed CBV deficits in the pre-IH CTP. No statistically significant difference (p=0.310) was observed between CBF, CBV and MTT deficits between pre-IH and post-IH CTP. Amongst patients with deficits in the pre-IH CTP, a total of n=12 progressed to infarction in the post-IH CTP.

Conclusion: Our study suggests that IH is not sufficient to prevent the development of infarction in patients with radiologically confirmed perfusion deficits in CTP after aSAH. A more aggressive treatment strategy appears to be warranted in order to prevent irreversible brain tissue loss.