Cerebral Vasospasm After Subarachnoid Hemorrhage, Subarachnoid Aneurysm Hemorrhage
Conditions
Keywords
Transcranial Doppler, Endoluminal Spasmolysis, Induced Hypertension, Multimodal Neuromonitoring
Brief summary
An observational study of patients with emerging or established severe cerebral vasospasm after subarachnoid haemorrhage, employing multimodal neuromonitoring.
Interventions
Induced hypertension with norepinephrine and/or dobutamine to attain clinically established goals of cerebral perfusion pressure in a stepwise fashion, according to clinical routine.
DRUGEndoluminal Spasmolysis
Endoluminal spasmolysis of cerebral arteries using i.a. Nimodipine, according to clinical protocol and neurointerventionist discretion.
Sponsors
Karolinska Institutet
Region Stockholm
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults 18 years or older * Critical care after subarachnoid haemorrhage * Aneurysm secured by surgical clipping or endovascular procedure * Suspected, emerging or established severe cerebral vasospasm
Exclusion criteria
* Anticipated survival less than five days, as determined by treating clinician * Transcranial Doppler signal too weak * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Flow Velocity (MFV) | Up to 12 hours post intervention | Increase or decrease of Mean Flow Velocity of the medial cerebral artery as determined by Transcranial Doppler. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of MFV change after Endoluminal Spasmolysis | Up to 12 hours | Time until Mean Flow Velocity, as determined by Transcranial Doppler, returns to or surpasses baseline. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Associations between Mean Flow Velocity and multimodal neurophysiologic measurement variables after endoluminal spasmolysis or induced hypertension. | Up to 12 hours | Associations between Mean Flow Velocities, as determined by Transcranial Doppler, and other neurophysiologic measurement variables, such as pbtO2 (partial pressure brain tissue oxygenation), SbtO2 (brain tissue saturation), qEEG (quantitative EEG), microdialysis parameters, Prx (pressure reactivity index), as well as other physiologic output parameters such as cardiac output, (as determined by left ventricular output or effective pulmonary blood flow (EPBF)). |
| Associations between Mean Flow Velocity and neuroradiological outcome after induced hypertension or endoluminal spasmolysis. | Up to 12 hours | Associations between Mean Flow Velocity, as determined by Transcranial Doppler, and neuroradiologic outcome parameters such as cerebral artery diameter, perfusion parameters, mean transit time (MTT), ischemic burden. |
Countries
Sweden
Contacts
Primary ContactPeter C Rudberg, M.D. Ph.D.
Backup ContactAnja Rosén, M.D.
Outcome results
None listed