RT Journal Article
SR Electronic
T1 Cerebral Perfusion Pressure is Maintained in Acute Intracerebral Hemorrhage: A CT Perfusion Study
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 244
OP 251
DO 10.3174/ajnr.A4532
VO 37
IS 2
A1 A.S. Tamm
A1 R. McCourt
A1 B. Gould
A1 M. Kate
A1 J.C. Kosior
A1 T. Jeerakathil
A1 L.C. Gioia
A1 D. Dowlatshahi
A1 M.D. Hill
A1 S.B. Coutts
A1 A.M. Demchuk
A1 B.H. Buck
A1 D.J. Emery
A1 A. Shuaib
A1 K.S. Butcher
YR 2016
UL http://www.ajnr.org/content/37/2/244.abstract
AB BACKGROUND AND PURPOSE: Although blood pressure reduction has been postulated to result in a fall in cerebral perfusion pressure in patients with intracerebral hemorrhage, the latter is rarely measured. We assessed regional cerebral perfusion pressure in patients with intracerebral hemorrhage by using CT perfusion source data.MATERIALS AND METHODS: Patients with acute primary intracerebral hemorrhage were randomized to target systolic blood pressures of <150 mm Hg (n = 37) or <180 mm Hg (n = 36). Regional maps of cerebral blood flow, cerebral perfusion pressure, and cerebrovascular resistance were generated by using CT perfusion source data, obtained 2 hours after randomization.RESULTS: Perihematoma cerebral blood flow (38.7 ± 11.9 mL/100 g/min) was reduced relative to contralateral regions (44.1 ± 11.1 mL/100 g/min, P = .001), but cerebral perfusion pressure was not (14.4 ± 4.6 minutes−1 versus 14.3 ± 4.8 minutes−1, P = .93). Perihematoma cerebrovascular resistance (0.34 ± 0.11 g/mL) was higher than that in the contralateral region (0.30 ± 0.10 g/mL, P < .001). Ipsilateral and contralateral cerebral perfusion pressure in the external (15.0 ± 4.6 versus 15.6 ± 5.3 minutes−1, P = .15) and internal (15.0 ± 4.8 versus 15.0 ± 4.8 minutes−1, P = .90) borderzone regions were all similar. Borderzone cerebral perfusion pressure was similar to mean global cerebral perfusion pressure (14.7 ± 4.7 minutes−1, P ≥ .29). Perihematoma cerebral perfusion pressure did not differ between blood pressure treatment groups (13.9 ± 5.5 minutes−1 versus 14.8 ± 3.4 minutes−1, P = .38) or vary with mean arterial pressure (r = −0.08, [−0.10, 0.05]).CONCLUSIONS: Perihematoma cerebral perfusion pressure is maintained despite increased cerebrovascular resistance and reduced cerebral blood flow. Aggressive antihypertensive therapy does not affect perihematoma or borderzone cerebral perfusion pressure. Maintenance of cerebral perfusion pressure provides physiologic support for the safety of blood pressure reduction in intracerebral hemorrhage.BPblood pressureBZborderzoneCPPcerebral perfusion pressureCVRcerebrovascular resistanceICHintracerebral hemorrhageICH ADAPTIntracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial