Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome

Fontana, Johann; Moratin, Julius; Ehrlich, Gregory; Scharf, Johann; Weiß, Christel; Schmieder, Kirsten; Barth, Martin

doi:10.1007/s12028-014-0104-7

Cited by 31 publications

(37 citation statements)

References 55 publications

(77 reference statements)

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“…These findings are in line with another recent publication which demonstrated a continuous decline of the ARI values from day 1 till 8 in patients with an unfavorable clinical outcome (mRS ˂3) in contrast to a continuous improvement of the ARI values in patients with a favorable clinical outcome (mRS ≥3). In addition, a significant correlation between the median ARI values from day 1 till 8 with the degree of angiographic proximal and distal VS could be detected . The current preliminary results seem to demonstrate that the individual decline of CA values in group A‐ is abrupt and can occur any time during the postbleeding course.…”

Section: Discussionsupporting

confidence: 58%

“…The ability of the brain to regulate cerebral blood flow upon blood pressure variations has been described as cerebral pressure autoregulation (CA) . Previous data demonstrated an impairment of CA after aneurysmal subarachnoid hemorrhage (SAH) . Furthermore, it has been demonstrated that occurrence of an early disturbance of autoregulation after SAH is associated with delayed cerebral ischemia (DCI) .…”

Section: Introductionmentioning

confidence: 99%

“…Thus, it appears that these methods cannot be used interchangeably in describing the actual status of CA and no consensus exists which measurement approach most suitably describes the degree and time course of impaired CA. We recently demonstrated a significant correlation between an impaired CA and the occurrence of angiographic vasospasm (VS) and an unfavorable clinical outcome after SAH . However, it remains unclear if an impaired CA is an early, maybe reversible, step in a chain reaction resulting in VS and delayed infarcts or if this CA impairment is only a passive side effect of a progressive clinical deterioration due to VS and delayed infarcts.…”

Section: Introductionmentioning

confidence: 99%

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Impairment of Dynamic Pressure Autoregulation Precedes Clinical Deterioration after Aneurysmal Subarachnoid Hemorrhage

Fontana

Wenz

Schmieder

et al. 2015

Journal of Neuroimaging

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impairment of Dynamic Pressure Autoregulation Precedes Clinical Deterioration after Aneurysmal Subarachnoid Hemorrhage

Fontana

Wenz

Schmieder

et al. 2015

Journal of Neuroimaging

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“…However, a link between these physiologic derangements and an increased sensitivity to nimodipine remains unproven. While patients with higher grades of subarachnoid hemorrhage may have a greater impairment of cerebral autoregulatory capacity in the days following the ictus, a clear explanation for a greater sensitivity to nimodipine’s hypotensive effect is lacking (47–51). Many patients with high Hunt and Hess subarachnoid hemorrhage exhibit increased cardiac troponin I release, regional wall motion abnormalities on echocardiogram, and are more likely to require vasopressor/inotropic infusions (52).…”

Section: Discussionmentioning

confidence: 99%

High Compliance with Scheduled Nimodipine Is Associated with Better Outcome in Aneurysmal Subarachnoid Hemorrhage Patients Cotreated with Heparin Infusion

et al. 2017

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IntroductionWe sought to determine whether compliance with scheduled nimodipine in subarachnoid hemorrhage patients impacted patient outcomes, with the intent of guiding future nimodipine management in patients who experience nimodipine-induced hypotension.MethodsWe performed a retrospective analysis of 118 consecutive aneurysmal subarachnoid hemorrhage patients treated with the Maryland Low-Dose IV Heparin Infusion Protocol. Patients were categorized into three independent nimodipine compliance groups: ≥1 dose held, ≥1 dose split, and no missed or split-doses. A split-dose was defined as 30 mg of nimodipine administered every 2 h. Our primary outcome was discharge to home. Bivariate and multivariable logistic regression analyses were used to assess predictors of discharge disposition as a function of nimodipine compliance.ResultsOf the 118 patients, 20 (17%) received all nimodipine doses, 6 (5%) received split-doses but never had a full dose held, and 92 (78%) had ≥1 dose held. Forty-five percent of patients were discharged to home, including 75% who received all doses, 67% who received ≥1 split-doses, and 37% with ≥1 missed doses (p = 0.003). Multivariable analysis showed that, along with age and World Federation of Neurosurgical Societies grade, nimodipine compliance was an independent predictor of clinical outcome; compared to missing one or more nimodipine doses, full dosing compliance was associated with increased odds of discharge to home (odds ratio 5.20; 95% confidence intervals 1.46–18.56).ConclusionIn aneurysmal subarachnoid hemorrhage patients with modified Fisher scores 2 through 4 who are cotreated with a low-dose heparin infusion, full compliance with nimodipine dosing was associated with increased odds of discharge to home.

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“…In aneurysmal subarachnoid hemorrhage (SAH), CPA may be disturbed to different extents [15]. Disturbed CPA in SAH is associated with delayed cerebral ischemia (DCI), vasospasm and unfavorable outcome [5, 7, 16].…”

Section: Introductionmentioning

confidence: 99%

Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP

et al. 2017

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BackgroundCerebral pressure autoregulation can be quantified with the pressure reactivity index (PRx), based on the correlation between blood pressure and intracranial pressure. Using PRx optimal cerebral perfusion pressure (CPPopt) can be calculated, i.e., the level of CPP where autoregulation functions best. The relation between cerebral blood flow (CBF) and CPPopt has not been examined. The objective was to assess to which extent CPPopt can be calculated in SAH patients and to investigate CPPopt in relation to CBF.MethodsRetrospective study of prospectively collected data. CBF was measured bedside with Xenon-enhanced CT (Xe-CT). The difference between actual CPP and CPPopt was calculated (CPP∆). Correlations between CPP∆ and CBF parameters were calculated with Spearman’s rank order correlation coefficient (rho). Separate calculations were done using all patients (day 0–14 after onset) as well as in two subgroups (day 0–3 and day 4–14).ResultsEighty-two patients with 145 Xe-CT scans were studied. Automated calculation of CPPopt was possible in adjunct to 60% of the Xe-CT scans. Actual CPP < CPPopt was associated with higher numbers of low-flow regions (CBF <10 ml/100 g/min) in both the early phase (day 0–3, n = 39, Spearman’s rho = −0.38, p = 0.02) and late acute phase of the disease (day 4–14, n = 35, Spearman’s rho = −0.39, p = 0.02). CPP level per se was not associated with CBF.ConclusionsCalculation of CPPopt is possible in a majority of patients with severe SAH. Actual CPP below CPPopt is associated with low CBF.

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Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome

Abstract: Early deterioration of CA significantly correlates with unfavorable clinical outcome and severity of angiographic vasospasm. Dynamic CA measurements might represent an important tool in stratifying therapy guidelines in patients after SAH.

Cited by 31 publications

References 55 publications

Impairment of Dynamic Pressure Autoregulation Precedes Clinical Deterioration after Aneurysmal Subarachnoid Hemorrhage

Impairment of Dynamic Pressure Autoregulation Precedes Clinical Deterioration after Aneurysmal Subarachnoid Hemorrhage

High Compliance with Scheduled Nimodipine Is Associated with Better Outcome in Aneurysmal Subarachnoid Hemorrhage Patients Cotreated with Heparin Infusion

Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP

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