2021
DOI: 10.3389/fneur.2021.729831
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Intracranial Pressure and Cerebral Perfusion Pressure in Large Spontaneous Intracranial Hemorrhage and Impact of Minimally Invasive Surgery

Abstract: Introduction: We investigated the effect of hematoma volume reduction with minimally invasive surgery (MIS) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with large spontaneous intracerebral hemorrhage (ICH).Methods:Post-hoc analysis of the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE III) study, a clinical trial with blinded outcome assessments. The primary outcome was the proportion of ICP readings ≥20 and 30 mmHg, and CPP readin… Show more

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Cited by 13 publications
(11 citation statements)
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“…Among hospital events, need for intracranial pressure monitoring (MISTIE-III) and cerebral perfusion pressure less than 60 mm Hg (CLEAR-III) were associated with persistent poor outcome. In CLEAR-III, any cerebral perfusion pressure less than 60 mm Hg negatively influenced functional recovery even though intracranial pressure elevation did not, similar to findings from a prior MISTIE-III analysis, which also reported cerebral perfusion pressure as an independent predictor of poor long-term outcome . This suggests that cerebral hypoperfusion may be more critical than intracranial hypertension, raising concerns about aggressive blood pressure reduction in patients with large hematomas .…”
Section: Discussionsupporting
confidence: 66%
See 1 more Smart Citation
“…Among hospital events, need for intracranial pressure monitoring (MISTIE-III) and cerebral perfusion pressure less than 60 mm Hg (CLEAR-III) were associated with persistent poor outcome. In CLEAR-III, any cerebral perfusion pressure less than 60 mm Hg negatively influenced functional recovery even though intracranial pressure elevation did not, similar to findings from a prior MISTIE-III analysis, which also reported cerebral perfusion pressure as an independent predictor of poor long-term outcome . This suggests that cerebral hypoperfusion may be more critical than intracranial hypertension, raising concerns about aggressive blood pressure reduction in patients with large hematomas .…”
Section: Discussionsupporting
confidence: 66%
“…In CLEAR-III, any cerebral perfusion pressure less than 60 mm Hg negatively influenced functional recovery 41 even though intracranial pressure elevation did not, similar to findings from a prior MISTIE-III analysis, which also reported cerebral perfusion pressure as an independent predictor of poor long-term outcome. 42 This suggests that cerebral hypoperfusion may be more critical than intracranial hypertension, raising concerns about aggressive blood pressure reduction in patients with large hematomas. [43][44][45] Ischemic stroke in the first month was also associated with lack of functional recovery, which is associated with leukoaraiosis, high-volume hemorrhage, and rapid blood-pressure reduction.…”
Section: Sensitivity Analysesmentioning
confidence: 99%
“…In patients with large ICH (>30 mL) requiring ICP monitoring or severe IVH requiring EVD, the burden of low cerebral perfusion pressure (CPP) <60 and <70 mm Hg was associated with increased mortality and poor functional outcomes, respectively, suggesting that BP reduction be accompanied by maintenance of CPP of 60 to ≥70 mm Hg in patients with large ICH, ICP elevation, or compromised CPP. 159,160…”
Section: Medical and Neurointensive Treatment For Ichmentioning
confidence: 99%
“…353 Secondary analyses of the ERICH (Ethnic/ Racial Variations of Intracerebral Hemorrhage) and MISTIE III (Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation) data do not support the routine use of ICP monitoring in patients with ICH, 351,375 although long-term mortality in MISTIE III was significantly associated with higher proportion of time with high ICP and low CPP in monitored patients. 160 Shortcomings inherent to retrospective studies or secondary analyses such as small sample size and selection biases should be considered in the interpretation of these findings.…”
Section: The Frequency At Which Icp Elevations Occur Aftermentioning
confidence: 99%
“…The results of this study are consistent with previously reported relevant literature. [14][15][16][17] This provides an effective reference for the treatment of medium-and large-volume intracranial hematoma.…”
mentioning
confidence: 99%