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  • Asdaghi, Negar  (4)
  • Demchuk, Andrew M  (4)
  • Shuaib, Ashfaq  (4)
  • 1
    Online Resource
    Online Resource
    Abstract WP295: Acute Blood Pressure Reduction in Intracerebral Hemorrhage Patients Does Not Increase Hypoperfused Tissue Volume: a CT Perfusion Threshold Study
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT) demonstrated that aggressive blood pressure (BP) reduction does not affect mean perihematoma cerebral blood flow (CBF). It remains unknown if portions of the perihematoma region or watershed vascular territories (borderzones, BZs) reach ischemic thresholds after BP reduction. We tested the hypothesis that aggressive BP reduction was associated with an increased volume of critically hypoperfused tissue in ICH ADAPT patients. Methods: ICH patients were randomized to a target systolic BP (SBP) of 〈 150 or 〈 180 mmHg and imaged with CT perfusion (CTP) 2h later. A 1cm perihematoma region, and ipsilateral and contralateral internal and external BZs were outlined. The volume of tissue below CBF thresholds for ischemia ( 〈 18ml/100g/min) and infarction ( 〈 12ml/100g/min) was calculated as a percentage of the total volume of each region of interest. Results: ICH patients (n=73) were randomized a median (IQR) of 7.8 (13.3) h from onset and imaged with CTP 2.3 (1.0) h later. Acute hematoma volume was 17.8 (27.1) ml and mean SBP was 183±22 mmHg. At the time of CTP, SBP was lower in the 〈 150 mmHg group (n=37, 140±18 mmHg) than the 〈 180 mmHg group (n=36, 162±12 mmHg, P 〈 0.001). Mean CBF in the perihematoma region did not differ between groups ( 〈 150 mmHg: 38.9±13.0 vs. 〈 180 mmHg: 38.5±10.9 ml/100g/min, P=0.86). BP treatment did not affect the percentage of perihematoma tissue with CBF 〈 18 (17.5±15.4 ( 〈 150 group) vs. 16.5±14.3% ( 〈 180 group), P=0.82) or 〈 12 ml/100g/min (7.0±7.2 vs. 6.6±7.6%, P=0.93). Similar results were found in all BZs. Linear regression revealed no relationship between low SBP load (the fraction of time between randomization and CTP with SBP 〈 150mmHg) and the percentage of perihematoma tissue with CBF 〈 18 (β=3.62, [-6.86, 14.10]) or 〈 12 ml/100g/min (β=1.89, [-3.30, 7.08]). There was no relationship between low SBP load and percentage of hypoperfused tissue in any BZ. Perfusion threshold analysis of time domain parameters and cerebral blood volume yielded similar results. Conclusion: BP reduction does not increase the volume of hypoperfused tissue, at any threshold examined, in the perihematoma region or any BZ. These data support the safety of early BP reduction in ICH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP295
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Abstract TMP81: Cerebral Blood Flow and Blood Pressure Reduction Do Not Affect Perihematomal Edema Growth in Acute Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Both vasogenic and cytotoxic (ischemic) processes have been postulated to play a role in perihematoma edema formation. In the Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT), cerebral blood flow (CBF) was measured in ICH patients assigned to systolic blood pressure (SBP) targets of 〈 150 or 〈 180 mmHg. In this secondary analysis, we tested the hypotheses that edema growth is associated with reduced CBF and lower SBP. Methods: Non-contrast CT scans were obtained at baseline, 2h and 24h post-randomization. Mean relative CBF (rCBF) in the perihematoma region was calculated from raw CT Perfusion data obtained at 2h. Edema volume was measured using planimetric techniques and a Hounsfield unit threshold of ≤24 at baseline and 24h. Results: ICH patients were randomized (n=33 per group) at a median (IQR) of 7.6 (12.8) h after symptom onset. Mean SBP was significantly lower in the 〈 150 mmHg (139±21 mmHg) than the 〈 180 mmHg (163±11, p= 〈 0.0001) at the time of CTP. Mean perihematoma rCBF in the 〈 150 mmHg group (0.85±0.12) was similar to that in the 〈 180 mmHg group (0.88±0.09, p=0.34). Treatment groups were balanced with respect to baseline SBP (180±18 vs. 185±25 mmHg, p=0.39) and acute ICH volume (20.7±22.0 vs. 28.0±25.8 ml, p=0.22). In all patients, median edema volume increased significantly between the baseline 1.8(2.5) ml and 24 h scans (3.1 (5.1) ml, p 〈 0.0001). Linear regression indicated that ICH expansion predicted edema growth (β =0.3 [0.0, 0.2]). Lower perihematoma rCBF did not predict edema growth independently of ICH expansion (β =-0.2 [-229.5, 0.4] ). Mean edema growth in the 〈 150 group (2.4±6.9) was similar to that in the 〈 180 group (2.9±6.4, p=0.737). Edema growth was not predicted by SBP change (β=0.12 [-0.45, 1.22]). Neither low SBP load (fraction of time SBP 〈 150 mmHg over 24 h; β=0.07 [-0.13, 0.24]) nor high SBP load (time SBP 〉 180 mmHg; β=0.07 [-0.13, 0.24]) predicted edema growth. Conclusion: Perihematoma edema growth is explained by ICH volume expansion. Lower perihematoma CBF and BP treatment do not exacerbate edema growth. These data are not consistent with a cytotoxic mechanism of edema formation and support the safety of early BP treatment.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATMP81
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Abstract 113: The Intracerebral Haemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT): Final Results.
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Acute blood pressure (BP) reduction aimed at attenuation of intracerebral hemorrhage (ICH) expansion might also result in a harmful compromise of cerebral blood flow (CBF) in the region surrounding the hematoma. We tested the hypothesis that CBF in acute ICH patients is affected by BP reduction. Methods: Seventy-five patients with spontaneous ICH with baseline systolic BP 〉 150 mmHg were randomly assigned to an intravenous antihypertensive treatment protocol (labetalol, hydralazine and enalapril) targeting a systolic BP of either 〈 150 mmHg or 〈 180 mmHg within 24 hours of symptom onset. Patients underwent CT perfusion (CTP) imaging 2 hours post-randomization. The primary endpoint was relative CBF (rCBF) within the 1 cm perihematoma region. Results: Treatment groups were balanced with respect to baseline systolic BP: 182±20 mmHg ( 〈 150 mmHg target group, n=39) vs. 184±25 mmHg ( 〈 180 mmHg target group, n=36, p=0.60), hematoma volume: 25.6±30.8 vs. 26.9±25.2 ml (p=0.66) and median (IQR) time to randomization: 7.8 (13.5) and 8.5 (11.9) h (p=0.94). Mean systolic BP two hours after randomization was significantly lower in the 〈 150 mmHg target group (140±19 vs 162±12 mmHg in the 〈 180 target group, p 〈 0.001). Perihematoma CBF (38.7±11.9 ml/100g/min) was lower than in contralateral homologous regions (44.1±11.1 ml/100g/min, p 〈 0.001) in all patients. The primary endpoint of perihematoma rCBF in the 〈 150 mmHg target group (0.86±0.12) was not significantly lower than that in the 〈 180 mmHg group (0.89±0.09, p=0.19; absolute difference 0.03 95% CI -0.018, 0.078). There was no relationship between the magnitude of the BP change and perihematoma rCBF in the 〈 150 mmHg (R=0.00005, 95% CI -0.001, 0.001) or 〈 180 mmHg target groups (R=0.000, 95% CI -0.001, 0.001). There were no effects on rCBF in patients treated within 6 hours (0.78±0.22 in the 〈 150 mmHg group and 0.88±0.10 in the 〈 180 mmHg group, p=0.08) or in those treated 6-24 hours after onset (0.85±0.21 in the 〈 150 mmHg group and 0.89±0.10 in the 〈 180 mmHg group, p=0.46). Conclusions: Rapid BP lowering following ICH does not reduce perihematoma CBF. These physiological data support the safety of acute and aggressive BP reduction following ICH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.A113
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Perihematoma Cerebral Blood Flow is Unaffected by Statin Use in Acute Intracerebral Hemorrhage Patients
    SAGE Publications ; 2015
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 35, No. 7 ( 2015-07), p. 1175-1180
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 35, No. 7 ( 2015-07), p. 1175-1180
    Abstract: Statin therapy has been associated with improved cerebral blood flow (CBF) and decreased perihematoma edema in animal models of intracerebral hemorrhage (ICH). We aimed to assess the relationship between statin use and cerebral hemodynamics in ICH patients. A post hoc analysis of 73 ICH patients enrolled in the Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT). Patients presenting 〈 24 hours from ICH onset were randomized to a systolic blood pressure target 〈 150 or 〈 180 mm Hg with computed tomography perfusion imaging 2 hours after randomization. Cerebral blood flow maps were calculated. Hematoma and edema volumes were measured planimetrically. Regression models were used to assess the relationship between statin use, perihematoma edema and cerebral hemodynamics. Fourteen patients (19%) were taking statins at the time of ICH. Statin-treated patients had similar median (IQR Q25 to 75) hematoma volumes (21.1 (9.5 to 38.3) mL versus 14.5 (5.6 to 27.7) mL, P = 0.25), but larger median (IQR Q25 to 75) perihematoma edema volumes (2.9 (1.7 to 9.0) mL versus 2.2 (0.8 to 3.5) mL, P = 0.02) compared with nontreated patients. Perihematoma and ipsilateral hemispheric CBF were similar in both groups. A multivariate linear regression model revealed that statin use and hematoma volumes were independent predictors of acute edema volumes. Statin use does not affect CBF in ICH patients. Statin use, along with hematoma volume, are independently associated with increased perihematoma edema volume.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/jcbfm.2015.36
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2039456-1
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