Open AccessJournal Article
急性脳内出血における血腫と血腫周囲浮腫の拡大に対する早期の集中的降圧治療の効果--Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial(INTERACT)
TLDR
Early intensive BP-lowering treatment attenuated hematoma growth over 72 hours in intracerebral hemorrhage and there were no appreciable effects on perihematomal edema.Abstract:
Background and Purpose— The Intensive Blood Pressure Reduction In Acute Cerebral Haemorrhage Trial (INTERACT) study suggests that early intensive blood pressure (BP) lowering can attenuate hematoma growth at 24 hours after intracerebral hemorrhage. The present analyses aimed to determine the effects of treatment on hematoma and perihematomal edema over 72 hours. Methods— INTERACT included 404 patients with CT-confirmed intracerebral hemorrhage, elevated systolic BP (150 to 220 mm Hg), and capacity to start BP-lowering treatment within 6 hours of intracerebral hemorrhage. Patients were randomly assigned to an intensive (target systolic BP 140 mmHg) or standard guideline-based management of BP (target systolic BP 180 mm Hg) using routine intravenous agents. Baseline and repeat CTs (24 and 72 hours) were performed using standardized techniques with digital images analyzed centrally. Outcomes were increases in hematoma and perihematomal edema volumes over 72 hours. Results— Overall, 296 patients had all 3 CT scans available for the hematoma and 270 for the edema analyses. Mean systolic BP was 11.7 mm Hg lower in the intensive group than in the guideline group during 1 to 24 hours. Adjusted mean absolute increases in hematoma volumes (mL) at 24 and 72 hours were 2.40 and 0.15 in the guideline group compared with −0.74 and −2.31 in the intensive group, respectively, an overall difference of 2.80 (95% CI, 1.04 to 4.56; P=0.002). Adjusted mean absolute increases in edema volumes (mL) at 24 and 72 hours were 6.27 and 10.02 in the guideline group compared with 4.19 and 7.34 in the intensive group, respectively, for an overall difference of 2.38 (95% CI, −0.45 to 5.22; P=0.10). Conclusion— Early intensive BP-lowering treatment attenuated hematoma growth over 72 hours in intracerebral hemorrhage. There were no appreciable effects on perihematomal edema.read more
Citations
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Intensive blood pressure reduction in acute cerebralhaemorrhage trial (INTERACT): a randomised pilot trial
Craig S. Anderson,Hisatomi Arima,John Chalmers,Emma Heeley,Stephane Heritier,Bruce Neal,Bin Peng,Christian Skulina,Yan Cheng,Yining Huang,Jiang Dong Jiang,Sung Kim Jong,Wen Tai Li,Lewis B. Morgenstern,Mark W Parsons,Qing Ling Tao,Jiguang Wang,En Xu,Jin Li Zhang +18 more
TL;DR: Early intensive BP-lowering treatment is clinically feasible, well tolerated, and seems to reduce haematoma growth in ICH, a large randomised trial needed to define the effects on clinical outcomes across a broad range of patients with ICH.
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The haematoma expansion paradoxes. A study of haematoma expansion in acute primary intracerebral haemorrhage
TL;DR: An observational longitudinal study on retrospectively collected data on 206 consecutive patients with primary or anticoagulant-associated ICH admitted to the Stroke Units of the Neurology Units of Treviso Hospital and St. Anthony's Hospital of Padova, confirmed the complexity of the haematoma expansion phenomenon.
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Brain edema formation and therapy after intracerebral hemorrhage
TL;DR: In this article , the authors discuss the mechanisms underlying perihematomal brain edema formation, the effects of sex and age, as well as how the edema is resolved.
El spot sign y spot sign score en el hematoma cerebral espontáneo: aplicaciones clínicas en la urgencia de neuroradiología
TL;DR: El spot sign obtuvo una sensibilidad, especificidad y valor predictivo negativo relativamente alto indicando that es una herramienta diagnostica fiable en the deteccion del posible crecimiento de un hematoma intraparenquimatoso.
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Thomas Brott,Joseph P. Broderick,Rashmi Kothari,William G. Barsan,Thomas A. Tomsick,Laura Sauerbeck,Judith Spilker,John Duldner,Jane Khoury +8 more
TL;DR: Substantial early hemorrhage growth in patients with intracerebral hemorrhage is common and is associated with neurological deterioration, and Randomized treatment trials are needed to determine whether this early natural history of ongoing bleeding and frequent neurological deterioration can be improved.
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Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage
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TL;DR: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability, and an ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive loweringof blood pressure.