Monitoring treatment of delayed cerebral ischaemia in unconscious patients after aneurysmal subarachnoid haemorrhage: a prospective multimodal neuromonitoring study.
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BORIS DOI
Publisher DOI
PubMed ID
41192974
Description
Background
Aneurysmal subarachnoid haemorrhage (SAH) is a life-threatening condition with high morbidity. Delayed cerebral ischaemia (DCI) significantly contributes to secondary injury and poor outcomes. While perfusion CT (CTP) aids DCI detection, multimodal neuromonitoring-including brain tissue oxygenation (PtiO2) and cerebral microdialysis-offers superior temporal resolution. Its value in guiding treatment remains underexplored.Methods
This prospective cohort study included SAH patients monitored with multimodal neuromonitoring at RWTH Aachen University Hospital (2014-2020). DCI was diagnosed with neuromonitoring abnormalities and confirmed by CTP. First-line treatment involved induced hypertension, with endovascular rescue treatment for refractory cases. Physiological data were time-aligned to treatment onset and aggregated into hourly summaries. Binomial logistic regression identified predictors of favourable 1-year outcome (modified Rankin Scale 0-3).Results
Of 56 patients with confirmed DCI, correctly placed probes and available outcome data, 22 (39.3%) achieved favourable outcome. These patients showed greater post-treatment reductions in pressure reactivity index (PRx) and lactate-to-pyruvate ratio (LPR). In multivariable analysis, greater PRx reduction was significantly associated with favourable outcome (OR 0.023, 95% CI 0.001 to 0.394, p=0.009), translating to a 46.5% increase in odds per 0.1-unit decrease. Greater LPR reductions were also predictive (OR 0.950, 95% CI 0.904 to 0.998, p=0.042), with a 5-unit drop linked to a 29.3% increase in odds. Although PtiO2₂ improved post-treatment, it was not associated with outcome.Conclusion
PRx and LPR reflect meaningful physiological responses to DCI treatment and are associated with 1-year outcomes. Multimodal neuromonitoring may support not only diagnosis but also treatment monitoring and decision-making in unconscious SAH patients.Trial Registration Number
German Clinical Trial Registry (DRKS00030505).
Aneurysmal subarachnoid haemorrhage (SAH) is a life-threatening condition with high morbidity. Delayed cerebral ischaemia (DCI) significantly contributes to secondary injury and poor outcomes. While perfusion CT (CTP) aids DCI detection, multimodal neuromonitoring-including brain tissue oxygenation (PtiO2) and cerebral microdialysis-offers superior temporal resolution. Its value in guiding treatment remains underexplored.Methods
This prospective cohort study included SAH patients monitored with multimodal neuromonitoring at RWTH Aachen University Hospital (2014-2020). DCI was diagnosed with neuromonitoring abnormalities and confirmed by CTP. First-line treatment involved induced hypertension, with endovascular rescue treatment for refractory cases. Physiological data were time-aligned to treatment onset and aggregated into hourly summaries. Binomial logistic regression identified predictors of favourable 1-year outcome (modified Rankin Scale 0-3).Results
Of 56 patients with confirmed DCI, correctly placed probes and available outcome data, 22 (39.3%) achieved favourable outcome. These patients showed greater post-treatment reductions in pressure reactivity index (PRx) and lactate-to-pyruvate ratio (LPR). In multivariable analysis, greater PRx reduction was significantly associated with favourable outcome (OR 0.023, 95% CI 0.001 to 0.394, p=0.009), translating to a 46.5% increase in odds per 0.1-unit decrease. Greater LPR reductions were also predictive (OR 0.950, 95% CI 0.904 to 0.998, p=0.042), with a 5-unit drop linked to a 29.3% increase in odds. Although PtiO2₂ improved post-treatment, it was not associated with outcome.Conclusion
PRx and LPR reflect meaningful physiological responses to DCI treatment and are associated with 1-year outcomes. Multimodal neuromonitoring may support not only diagnosis but also treatment monitoring and decision-making in unconscious SAH patients.Trial Registration Number
German Clinical Trial Registry (DRKS00030505).
Date of Publication
2025-11-04
Publication Type
Article
Subject(s)
Keyword(s)
Aneurysm
•
Cerebral Infarction
•
Hemorrhage
•
Intracranial Aneurysm
•
Subarachnoid
Language(s)
en
Contributor(s)
Veldeman, Michael | |
Bögli, Stefan Yu | |
Olakorede, Ihsane | |
Kastenholz, Nick | |
Conzen-Dilger, Catharina | |
Seyfried, Katharina Sophie | |
Beqiri, Erta | |
Weyland, Charlotte S | |
Clusmann, Hans | |
Schubert, Gerrit A | |
Hoellig, Anke | |
Smielewski, Peter |
Additional Credits
Series
Stroke and Vascular Neurology
Publisher
BMJ Publishing Group
ISSN
2059-8696
2059-8688
Access(Rights)
open.access