Cerebral perfusion and blood pressure do not affect perihematoma edema growth in acute intracerebral hemorrhage

Rebecca McCourt, Bronwen Gould, Laura Gioia, Mahesh Kate, Shelagh B. Coutts, Dariush Dowlatshahi, Negar Asdaghi, Thomas Jeerakathil, Michael D. Hill, Andrew M. Demchuk, Brian Buck, Derek Emery, Kenneth Butcher

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: The pathogenesis of perihematoma edema in intracerebral hemorrhage (ICH) is unknown but has been hypothesized to be ischemic. In the ICH Acutely Decreasing Arterial Pressure Trial (ICH ADAPT), perihematoma cerebral blood flow (CBF) was reduced but was unaffected by blood pressure (BP) reduction. Using ICH ADAPT data, we tested the hypotheses that edema growth is associated with reduced CBF and lower systolic BP. METHODS-: Noncontrast computed tomographic scans in patients with ICH were obtained at baseline, 2 hours, and 24 hours after randomization to target systolic BPs of <150 or <180 mm Hg. Computed tomography perfusion imaging was performed at 2 hours, and mean relative CBF was calculated in visibly edematous perihematoma tissue. Edema volumes were measured using a Hounsfield unit threshold of 5 to 23 at each time-point. RESULTS-: Patients were randomized at a median (interquartile range) of 7.4 (12.8) hours after onset. Treatment groups (n=34, <150 and n=33, <180 target) were balanced with respect to baseline systolic BP and acute ICH volume. Relative edema growth at 24 hours in the <150 group (0.11±0.19) was similar to that in the <180 group (0.09±0.16 mL; P=0.727). Absolute CBF was lower in the edematous region (35.67±13.1 mL/100 g per minute) when compared with that in the contralateral tissue (43.7±11.7 mL/100 g per minute; P<0.0001). Linear regression indicated that neither systolic BP change (β=-0.022; 95% confidence interval, -0.002 to 0.001) nor perihematoma relative CBF (β=-0.144; 95% confidence interval, -0.647 to 0.167) predicted edema growth. CONCLUSIONS-: Lower perihematoma CBF and BP treatment do not exacerbate edema growth. These data do not support a cytotoxic edema pathogenesis.

Original languageEnglish (US)
Pages (from-to)1292-1298
Number of pages7
JournalStroke
Volume45
Issue number5
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Cerebrovascular Circulation
Cerebral Hemorrhage
Edema
Blood Pressure
Growth
Confidence Intervals
Perfusion Imaging
Random Allocation
Linear Models
Arterial Pressure
Tomography

Keywords

  • Brain
  • Cerebral hemorrhage
  • Edema
  • Hypertension
  • Perfusion imaging

ASJC Scopus subject areas

  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology

Cite this

McCourt, R., Gould, B., Gioia, L., Kate, M., Coutts, S. B., Dowlatshahi, D., ... Butcher, K. (2014). Cerebral perfusion and blood pressure do not affect perihematoma edema growth in acute intracerebral hemorrhage. Stroke, 45(5), 1292-1298. https://doi.org/10.1161/STROKEAHA.113.003194

Cerebral perfusion and blood pressure do not affect perihematoma edema growth in acute intracerebral hemorrhage. / McCourt, Rebecca; Gould, Bronwen; Gioia, Laura; Kate, Mahesh; Coutts, Shelagh B.; Dowlatshahi, Dariush; Asdaghi, Negar; Jeerakathil, Thomas; Hill, Michael D.; Demchuk, Andrew M.; Buck, Brian; Emery, Derek; Butcher, Kenneth.

In: Stroke, Vol. 45, No. 5, 2014, p. 1292-1298.

Research output: Contribution to journalArticle

McCourt, R, Gould, B, Gioia, L, Kate, M, Coutts, SB, Dowlatshahi, D, Asdaghi, N, Jeerakathil, T, Hill, MD, Demchuk, AM, Buck, B, Emery, D & Butcher, K 2014, 'Cerebral perfusion and blood pressure do not affect perihematoma edema growth in acute intracerebral hemorrhage', Stroke, vol. 45, no. 5, pp. 1292-1298. https://doi.org/10.1161/STROKEAHA.113.003194
McCourt, Rebecca ; Gould, Bronwen ; Gioia, Laura ; Kate, Mahesh ; Coutts, Shelagh B. ; Dowlatshahi, Dariush ; Asdaghi, Negar ; Jeerakathil, Thomas ; Hill, Michael D. ; Demchuk, Andrew M. ; Buck, Brian ; Emery, Derek ; Butcher, Kenneth. / Cerebral perfusion and blood pressure do not affect perihematoma edema growth in acute intracerebral hemorrhage. In: Stroke. 2014 ; Vol. 45, No. 5. pp. 1292-1298.
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abstract = "BACKGROUND AND PURPOSE-: The pathogenesis of perihematoma edema in intracerebral hemorrhage (ICH) is unknown but has been hypothesized to be ischemic. In the ICH Acutely Decreasing Arterial Pressure Trial (ICH ADAPT), perihematoma cerebral blood flow (CBF) was reduced but was unaffected by blood pressure (BP) reduction. Using ICH ADAPT data, we tested the hypotheses that edema growth is associated with reduced CBF and lower systolic BP. METHODS-: Noncontrast computed tomographic scans in patients with ICH were obtained at baseline, 2 hours, and 24 hours after randomization to target systolic BPs of <150 or <180 mm Hg. Computed tomography perfusion imaging was performed at 2 hours, and mean relative CBF was calculated in visibly edematous perihematoma tissue. Edema volumes were measured using a Hounsfield unit threshold of 5 to 23 at each time-point. RESULTS-: Patients were randomized at a median (interquartile range) of 7.4 (12.8) hours after onset. Treatment groups (n=34, <150 and n=33, <180 target) were balanced with respect to baseline systolic BP and acute ICH volume. Relative edema growth at 24 hours in the <150 group (0.11±0.19) was similar to that in the <180 group (0.09±0.16 mL; P=0.727). Absolute CBF was lower in the edematous region (35.67±13.1 mL/100 g per minute) when compared with that in the contralateral tissue (43.7±11.7 mL/100 g per minute; P<0.0001). Linear regression indicated that neither systolic BP change (β=-0.022; 95{\%} confidence interval, -0.002 to 0.001) nor perihematoma relative CBF (β=-0.144; 95{\%} confidence interval, -0.647 to 0.167) predicted edema growth. CONCLUSIONS-: Lower perihematoma CBF and BP treatment do not exacerbate edema growth. These data do not support a cytotoxic edema pathogenesis.",
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AU - McCourt, Rebecca

AU - Gould, Bronwen

AU - Gioia, Laura

AU - Kate, Mahesh

AU - Coutts, Shelagh B.

AU - Dowlatshahi, Dariush

AU - Asdaghi, Negar

AU - Jeerakathil, Thomas

AU - Hill, Michael D.

AU - Demchuk, Andrew M.

AU - Buck, Brian

AU - Emery, Derek

AU - Butcher, Kenneth

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N2 - BACKGROUND AND PURPOSE-: The pathogenesis of perihematoma edema in intracerebral hemorrhage (ICH) is unknown but has been hypothesized to be ischemic. In the ICH Acutely Decreasing Arterial Pressure Trial (ICH ADAPT), perihematoma cerebral blood flow (CBF) was reduced but was unaffected by blood pressure (BP) reduction. Using ICH ADAPT data, we tested the hypotheses that edema growth is associated with reduced CBF and lower systolic BP. METHODS-: Noncontrast computed tomographic scans in patients with ICH were obtained at baseline, 2 hours, and 24 hours after randomization to target systolic BPs of <150 or <180 mm Hg. Computed tomography perfusion imaging was performed at 2 hours, and mean relative CBF was calculated in visibly edematous perihematoma tissue. Edema volumes were measured using a Hounsfield unit threshold of 5 to 23 at each time-point. RESULTS-: Patients were randomized at a median (interquartile range) of 7.4 (12.8) hours after onset. Treatment groups (n=34, <150 and n=33, <180 target) were balanced with respect to baseline systolic BP and acute ICH volume. Relative edema growth at 24 hours in the <150 group (0.11±0.19) was similar to that in the <180 group (0.09±0.16 mL; P=0.727). Absolute CBF was lower in the edematous region (35.67±13.1 mL/100 g per minute) when compared with that in the contralateral tissue (43.7±11.7 mL/100 g per minute; P<0.0001). Linear regression indicated that neither systolic BP change (β=-0.022; 95% confidence interval, -0.002 to 0.001) nor perihematoma relative CBF (β=-0.144; 95% confidence interval, -0.647 to 0.167) predicted edema growth. CONCLUSIONS-: Lower perihematoma CBF and BP treatment do not exacerbate edema growth. These data do not support a cytotoxic edema pathogenesis.

AB - BACKGROUND AND PURPOSE-: The pathogenesis of perihematoma edema in intracerebral hemorrhage (ICH) is unknown but has been hypothesized to be ischemic. In the ICH Acutely Decreasing Arterial Pressure Trial (ICH ADAPT), perihematoma cerebral blood flow (CBF) was reduced but was unaffected by blood pressure (BP) reduction. Using ICH ADAPT data, we tested the hypotheses that edema growth is associated with reduced CBF and lower systolic BP. METHODS-: Noncontrast computed tomographic scans in patients with ICH were obtained at baseline, 2 hours, and 24 hours after randomization to target systolic BPs of <150 or <180 mm Hg. Computed tomography perfusion imaging was performed at 2 hours, and mean relative CBF was calculated in visibly edematous perihematoma tissue. Edema volumes were measured using a Hounsfield unit threshold of 5 to 23 at each time-point. RESULTS-: Patients were randomized at a median (interquartile range) of 7.4 (12.8) hours after onset. Treatment groups (n=34, <150 and n=33, <180 target) were balanced with respect to baseline systolic BP and acute ICH volume. Relative edema growth at 24 hours in the <150 group (0.11±0.19) was similar to that in the <180 group (0.09±0.16 mL; P=0.727). Absolute CBF was lower in the edematous region (35.67±13.1 mL/100 g per minute) when compared with that in the contralateral tissue (43.7±11.7 mL/100 g per minute; P<0.0001). Linear regression indicated that neither systolic BP change (β=-0.022; 95% confidence interval, -0.002 to 0.001) nor perihematoma relative CBF (β=-0.144; 95% confidence interval, -0.647 to 0.167) predicted edema growth. CONCLUSIONS-: Lower perihematoma CBF and BP treatment do not exacerbate edema growth. These data do not support a cytotoxic edema pathogenesis.

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KW - Cerebral hemorrhage

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