Unsecured intracranial aneurysms and induced hypertension in cerebral vasospasm: is induced hypertension safe?

Abstract

BACKGROUND:

Induced hypertension is an established therapy to treat cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH) to prevent delayed ischemic deficits. Currently, there is minimal evidence available assessing the risk of induced hypertension in the presence of unsecured aneurysms. The aim of this study was to investigate the impact of induced hypertension on the rupturing of unsecured aneurysms in treating CVS.

METHODS:

We conducted a retrospective analysis between 1999 and 2009. Patients with unsecured aneurysms treated with induced hypertension were identified and stratified as having (1) additional unruptured unsecured aneurysms or (2) ruptured unsecured aneurysms. Hemodynamic parameters were analyzed and any bleeding recorded.

RESULTS:

Forty-five patients were included. Of those, 41 had 71 additional unruptured unsecured aneurysms and four patients had four ruptured unsecured aneurysms. The mean size of unsecured aneurysms was: 4.0 ± 1.9 mm (additional unruptured) and 5.3 ± 2.2 mm (ruptured), respectively. No aneurysm ruptured during therapy. Combining our data with previously published studies, there appears to be no increase of risk for aneurysm rupture by induced hypertension when compared to the natural history (0.5% for group 1, 2.9% for group 2).

CONCLUSION:

These data corroborate that induced hypertension may be a safe treatment option to prevent cerebral infarction in CVS, even in the presence of unsecured aneurysms. Our findings suggest that induced hypertension does not increase rupture of unsecured aneurysms. Given the high risk for cerebral infarction in severe CVS, we conclude that induced hypertension should not be omitted due to the presence of unsecured aneurysms.

• Authors: Johannes Platz, Erdem Güresir, Hartmut Vatter, Joachim Berkefeld, Volker Seifert, Andreas Raabe, Jürgen Beck
• Journal: Neurocritical care (Neurocrit Care) Vol. 14 Issue 2 Pg. 168-75 (Apr 2011) ISSN: 1556-0961 [Electronic] United States
• PMID: 21286853 (Publication Type: Journal Article)

Chemical References

• Sympathomimetics
• Dobutamine
• Dopamine
• Norepinephrine

Topics

• Adult
• Aged
• Aneurysm, Ruptured (epidemiology, physiopathology, therapy)
• Blood Volume (drug effects)
• Cerebrovascular Circulation (drug effects)
• Dobutamine (adverse effects)
• Dopamine (adverse effects)
• Female
• Humans
• Hypertension (chemically induced, epidemiology, physiopathology)
• Hypovolemia (drug therapy, epidemiology, physiopathology)
• Intracranial Aneurysm (epidemiology, physiopathology, therapy)
• Male
• Middle Aged
• Norepinephrine (adverse effects)
• Retrospective Studies
• Risk Factors
• Subarachnoid Hemorrhage (epidemiology, physiopathology, therapy)
• Sympathomimetics (adverse effects)
• Vasospasm, Intracranial (epidemiology, physiopathology, therapy)