Calviere Lionel, Gathier Celine S., Rafiq Marie, Koopman Inez, Rousseau Vanessa, Raposo Nicolas, Albucher Jean François, Viguier Alain, Geeraerts Thomas, Cognard Christophe, Rinkel Gabriel J E, Vergouwen Mervyn D I, Olivot Jean-Marc
Stroke Unit, CHU Toulouse, Toulouse, France.
Toulouse Neuroimaging Center, INSERM, UPS, Toulouse, France.
Front Neurol. 2022 Feb 21;13:836268. doi: 10.3389/fneur.2022.836268. eCollection 2022.
High systolic blood pressure (SBP) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with an increased risk of rebleeding. It remains unclear if an SBP lowering strategy before aneurysm treatment decreases this risk without increasing the risk of a delayed cerebral ischemia (DCI). Therefore, we compared the rates of in-hospital rebleeding and DCI among patients with aSAH admitted in two tertiary care centers with different SBP management strategies.
Retrospective cohort study. Consecutive patients from Utrecht and Toulouse admitted within 24 h after the aSAH onset were enrolled. In Toulouse, the target SBP before aneurysm treatment was ≤140 mm Hg, while, in Utrecht, an increased SBP was only treated in extreme situations. We compared SBP levels, the incidence of rebleeding within 24 h after admission, and DCI during hospitalization.
We enrolled 373 patients in Utrecht and 149 in Toulouse. The mean SBP on admission was similar but lower in Toulouse 4 h after admission (127.3 ± 17.4 vs. 138. ± 25.7 mmHg; < 0.0001). After a median delay of 3.7 h (IQR, 2.3-7.4) from admission, 4 patients (3%) in Toulouse . 29 (8%) in Utrecht experienced a rebleeding. After adjustment for Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) score, aneurysm size, age, and delay from ictus to admission, the HR was 0.66 (95% CI: 0.23-1.92). Incidence of DCI was 18% in Toulouse and 25% in Utrecht (adjusted OR, 0.68; 95% CI: 0.41-1.11).
Our results suggest that an intensive SBP lowering strategy between admission and aneurysm treatment does not decrease the risk of rebleeding and does not increase the risk of DCI compared to a more conservative strategy.
动脉瘤性蛛网膜下腔出血（aSAH）后高收缩压（SBP）与再出血风险增加相关。目前尚不清楚在动脉瘤治疗前降低SBP的策略是否能降低这种风险而不增加迟发性脑缺血（DCI）的风险。因此，我们比较了在两个采用不同SBP管理策略的三级医疗中心收治的aSAH患者的院内再出血率和DCI发生率。
回顾性队列研究。纳入aSAH发病后24小时内来自乌得勒支和图卢兹的连续患者。在图卢兹，动脉瘤治疗前的目标SBP≤140mmHg，而在乌得勒支，仅在极端情况下治疗升高的SBP。我们比较了SBP水平、入院后24小时内的再出血发生率以及住院期间的DCI发生率。
我们在乌得勒支纳入了373例患者，在图卢兹纳入了149例患者。入院时的平均SBP相似，但图卢兹入院后4小时的SBP较低（127.3±17.4 vs.138.±25.7mmHg；P<0.0001）。入院后中位延迟3.7小时（IQR，2.3 - 7.4），图卢兹有4例患者（3%）……乌得勒支有29例患者（8%）发生再出血。在调整动脉瘤性蛛网膜下腔出血入院预后（PAASH）评分、动脉瘤大小、年龄和发病至入院的延迟后，HR为0.66（95%CI：0.23 - 1.92）。图卢兹的DCI发生率为18%，乌得勒支为25%（调整后的OR，0.68；95%CI：0.41 - 1.11）。
我们的结果表明，与更保守的策略相比，在入院至动脉瘤治疗期间强化降低SBP的策略不会降低再出血风险，也不会增加DCI风险。
