The safety of vasopressor-induced hypertension in subarachnoid hemorrhage patients with coexisting unruptured, unprotected intracranial aneurysms.

Autor:	Reynolds MR; Department of Neurological Surgery, Washington University Medical School, St. Louis, Missouri;, Buckley RT; Department of Neurological Surgery, Washington University Medical School, St. Louis, Missouri;, Indrakanti SS; Department of Neurological Surgery, Washington University Medical School, St. Louis, Missouri;, Turkmani AH; Department of Neurological Surgery, University of Illinois at Chicago, Illinois;, Oh G; Department of Neurological Surgery, University of Illinois at Chicago, Illinois;, Crobeddu E; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;, Fargen KM; Department of Neurological Surgery, University of Florida, Gainesville, Florida; and., El Ahmadieh TY; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Naidech AM; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Amin-Hanjani S; Department of Neurological Surgery, University of Illinois at Chicago, Illinois;, Lanzino G; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;, Hoh BL; Department of Neurological Surgery, University of Florida, Gainesville, Florida; and., Bendok BR; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Zipfel GJ; Department of Neurological Surgery, Washington University Medical School, St. Louis, Missouri;
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2015 Oct; Vol. 123 (4), pp. 862-71. Date of Electronic Publication: 2015 Jul 24.
DOI:	10.3171/2014.12.JNS141201
Abstrakt:	Object: Vasopressor-induced hypertension (VIH) is an established treatment for patients with aneurysmal subarachnoid hemorrhage (SAH) who develop vasospasm and delayed cerebral ischemia (DCI). However, the safety of VIH in patients with coincident, unruptured, unprotected intracranial aneurysms is uncertain. Methods: This retrospective multiinstitutional study identified 1) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who required VIH therapy (VIH group), and 2) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who did not require VIH therapy (non-VIH group). All patients had previously undergone surgical or endovascular treatment for the presumed ruptured aneurysm. Comparisons between the VIH and non-VIH patients were made in terms of the patient characteristics, clinical and radiographic severity of SAH, total number of aneurysms, number of ruptured/unruptured aneurysms, aneurysm location/size, number of unruptured and unprotected aneurysms during VIH, severity of vasospasm, degree of hypervolemia, and degree and duration of VIH therapy. Results: For the VIH group (n = 176), 484 aneurysms were diagnosed, 231 aneurysms were treated, and 253 unruptured aneurysms were left unprotected during 1293 total days of VIH therapy (5.12 total years of VIH therapy for unruptured, unprotected aneurysms). For the non-VIH group (n = 73), 207 aneurysms were diagnosed, 93 aneurysms were treated, and 114 unruptured aneurysms were left unprotected. For the VIH and non-VIH groups, the mean sizes of the ruptured (7.2 ± 0.3 vs 7.8 ± 0.6 mm, respectively; p = 0.27) and unruptured (3.4 ± 0.2 vs 3.2 ± 0.2 mm, respectively; p = 0.40) aneurysms did not differ. The authors observed 1 new SAH from a previously unruptured, unprotected aneurysm in each group (1 of 176 vs 1 of 73 patients; p = 0.50). Baseline patient characteristics and comorbidities were similar between groups. While the degree of hypervolemia was similar between the VIH and non-VIH patients (fluid balance over the first 10 days of therapy: 3146.2 ± 296.4 vs 2910.5 ± 450.7 ml, respectively; p = 0.67), VIH resulted in a significant increase in mean arterial pressure (mean increase over the first 10 days of therapy relative to baseline: 125.1% ± 1.0% vs 98.2% ± 1.2%, respectively; p < 0.01) and systolic blood pressure (125.6% ± 1.1% vs. 104.1% ± 5.2%, respectively; p < 0.01). Conclusions: For small, unruptured, unprotected intracranial aneurysms in SAH patients, the frequency of aneurysm rupture during VIH therapy is rare. The authors do not recommend withholding VIH therapy from these patients.
Databáze:	MEDLINE
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