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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Withholding induced hypertension after subarachnoid haemorrhage reduces cardiovascular adverse events

Verzicht auf induzierte Hypertonie nach SAB reduziert unerwünschte kardiovaskuläre Ereignisse

Meeting Abstract

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  • presenting/speaker Marco Bissolo - Universitätsklinikum Freiburg, Neurochirurgie, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV052

doi: 10.3205/20dgnc056, urn:nbn:de:0183-20dgnc0567

Published: June 26, 2020

© 2020 Bissolo.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Induced hypertension (iHTN) is the mainstay of therapy for cerebral vasospasm (CVS) after subarachnoid hemorrhage (aSAH). Safety and efficacy of this treatment have been challenged by results from a recent randomized clinical trial (HIMALAIA).

Implementing cisternal blood clearance using stereotactic catheter ventriculostomy (STX-VCS) into clinical practice was associated with a decline of cerebral vasospasm and – consequentially – the use of iHTN. Here, we assess the effects of withholding iHTN in a consecutive and unselected aSAH cohort.

Methods: 441 consecutive aSAH patients admitted to our center in a 7-year period (04/2012 – 04/2019) were included in this study. STX-VCS was available in the second half (3.5 year period) and 57 of 215 patients (27%) considered at high risk for delayed cerebral ischemia (DCI) were offered STX-VCS on the basis of individual treatment decisions. Cisternal lavage was administered via STX-VCS using Urokinase or Nimodipine.

Adverse events (AEs) during intensive care therapy were recorded and graded according to the CTCAE terminology by a blinded physician who was not involved in the treatment of the patients. Cerebral vasospasm was recorded by transcranial doppler ultrasonography (TCD). The total daily dose of infusion fluids and norepinephrine were documented

Results: The mean prevalence of CVS (mean flow velocity > 160cm/s) during the first 21 days after aSAH was 34% BEFORE and 14% AFTER implementation of STX-VCS (p<0.0001). Consequentially, iHTN was applied in 96 of 226 (42.5%) patients BEFORE vs. 33 of 215 (15.3%) patients AFTER (p<0.0001). The mean daily volume of fluids applied in the BEFORE cohort was 6063ml vs 4813ml in the AFTER cohort (p<0.0001). The mean daily dose of norepinephrine was 60.8 mg vs. 42.8 mg (p=0.015), respectively.

Cardiovascular Adverse events occurred in 27.4% of patients BEFORE and 12.6% of patients AFTER (p<0.0001). Further adverse events occurred at comparable frequencies in both cohorts.

Conclusion: Implementing STX-VCS was associated with a 50% reduction of CVS. Withholding iHTN as CVS therapy was associated with a sharp decline of cardiovascular adverse events.

Figure 1 [Fig. 1]