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01-08-2017 | Editorial

CTP and DCI: We Need Clarification

Author: Thomas Mattingly

Published in: Neurocritical Care | Issue 1/2017

Excerpt

The work “Changes in Cerebral Perfusion with Induced Hypertension in Aneurysmal Subarachnoid Hemorrhage: a Pilot and Feasibility Study” by Murphy et al. [1] is a retrospective investigation regarding the utility of computed tomography perfusion (CTP) before and after treatment of delayed clinical ischemia (DCI) via induced hypertension (IH). This work builds on an extensive history of treatment of DCI using “triple H therapy” by applying an efficient and widely available method of measuring cerebral blood flow. The literature surveyed in this paper reflects the current conflict regarding treatment of DCI: namely, DCI is linked to worse outcomes after subarachnoid hemorrhage (SAH), but treatment of DCI has not been shown to improve outcomes. …

Murphy A, de Oliveira Manoel AL, Macdonald RL, et al. Changes in cerebral perfusion with induced hypertension in aneurysmal subarachnoid hemorrhage: a pilot and feasibility study. Neurocrit Care. 2017;. doi:10.1007/s12028-017-0379-6.PubMed

Treggiari MM, Deem S. Which H is the most important in triple-H therapy for cerebral vasospasm? Curr Opin Crit Care. 2009;15(2):83–6.CrossRefPubMed

Dankbaar JW, Slooter AJ, Rinkel GJ, et al. Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review. Crit Care. 2010;14:R23.CrossRefPubMedPubMedCentral

Keyrouz SG, Diringer MN. Clinical review: prevention and therapy of vasospasm in subarachnoid hemorrhage. Crit Care. 2007;11:220.CrossRefPubMedPubMedCentral

Mir DI, Gupta A, Dunning A, et al. CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2014;35:866–71.CrossRefPubMed

Cremers CH, van der Schaaf IC, Wensink E, et al. CT perfusion and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Cereb Blood Flow Metab. 2014;34:200–7.CrossRefPubMed

Gathier CS, Dankbaar JW, van der Jagt M, et al. Effects of induced hypertension on cerebral perfusion in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a randomized clinical trial. Stroke. 2015;46:327–81.CrossRef

Gathier CS, van den Bergh WM, Slooter AJ, et al. HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA): a randomized single-blind controlled trial of induced hypertension versus no induced hypertension in the treatment of delayed cerebral ischemia. Int J Stroke. 2014;9:375–80.CrossRefPubMed

Title: CTP and DCI: We Need Clarification
Author: Thomas Mattingly
Publication date: 01-08-2017
Publisher: Springer US
Published in: Neurocritical Care / Issue 1/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-017-0434-3

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