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London, United Kingdom 2013 20 Intracerebral/subarachnoid haemorrhage and venous diseases Blood Pressure Reduction Does Not Result in Perihematoma Misery Perfusion: A CT Perfu-sion E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 591 Study M.P. Kate1, V. Choi2, K. Mouridsen3, M.B. Hansen4, L. Ostergaard5, S. Jespersen6, M.D. Hill7, A.M. Demchuk8, S.B. Coutts9, K.S. Butcher10 University of Alberta, Edmonton, CANADA1, University of Alberta, Edmonton, CANADA2, Uni-versity of Aarhus, Aarhus, FINLAND3, University of Aarhus, Aarhus, FINLAND4, University of Aarhus, Aarhus, FINLAND5, University of Aarhus, Aarhus, 6, University of Calgary, Calgary, CAN-ADA7, University of Calgary, Calgary, CANADA8, University of Calgary, Calgary, CANADA9, University of Alberta, Edmonton, CANADA10 BACKGROUND: Blood pressure (BP) reduction in acute intracerebral hemorrhage (ICH) is con-troversial, due to concerns this may precipitate ischemia. We tested the hypothesis that BP reduction results in perihematoma misery perfusion, defined as an increase of >2 standard deviations of the mean contralateral OEF. METHODS: Acute ICH patients were randomized to a systolic BP target of <150 or <180 mmHg. Patients underwent CT perfusion (CTP) 2 h after randomization. Cere-bral Blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) maps based on flow heterogeneity were calculated from raw CTP data. The 1 cm perihe-matoma region was analyzed planimetrically. RESULTS: Sixty-five patients (median (IQR) age 69 (20)) were imaged at a median (IQR) time from onset to CTP of 9.8 (13.6) hours. Mean hematoma volume was 18.9±34.6 ml. Perihematoma CBF was significantly lower than contralateral homolo-gous regions (37.1±10.8 vs 44.8±10.3 ml/100g/min, p<0.001). Mean OEF was moderately elevated in the perihematoma region (0.44-0.12) relative to contralateral tissue (0.36-0.11, p<0.001). No pa-tients met the criteria for misery perfusion. Perihematoma CMRO2 (3.40-1.67 ml/100g/min) was slightly lower relative to contralateral tissue (3.63-1.66 ml/100g/min; p=0.025). Despite a significant difference in SBP between the aggressive (140.5-18.7 mmHg) and conservative (163.0±10.6 mmHg; p<0.001) treatment groups, perihematoma CBF was unaffected (37.2-11.9 vs. 35.8-9.6 ml/100g/min; p=0.307). Similarly, aggressive BP treatment did not affect OEF (0.43-0.12 vs. 0.45-0.11; p=0.232) or CMRO2 (3.16-1.66 vs. 3.68-1.85 ml/100g/min; p=0.857). CONCLUSIONS: The perihematoma region is moderately hypoperfused, resulting in a slight in-crease in OEF and lower CMRO2. There is no evidence of misery perfusion and oxygen metabolism is unaffected by BP reduction. These data support the safety of early aggressive BP treatment in ICH. 19 Intracerebral/subarachnoid haemorrhage and venous diseases No Spot Sign Predicts Favourable Long-term Outcome After Intracerebral Haemorrhage C. Ovesen1, I. Havsteen2, A.F. Christensen3, C.K. Hansen4, H. Christensen5 Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK1, De-partment of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK2, Department of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK3, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK4, Department of Neurology, Bispebjerg University Hospital, Copenhagen5 Background: Early prediction of risk of death and poor outcome in intracerebral haemorrhage (ICH) patients is essential in acute care and for future interventional trials. We investigated the ability of the spot sign to predict clinical functional 3-months outcome and long-term mortality. Method: From a prospective, consecutive single centre registry of acute stroke patients, we investigated the subset of patients with spontaneous ICH admitted within 4.5 hours after symptom onset from April 2009 to July 2012. Standard work up included computed tomography angiography (CTA) for spot sign status. Modified Rankin Scale (mRS) was assessed at 3 months (out-patient clinic or by tele-phone) and long-term mortality through the national electronic chart system for 3 – 39 months. Results: Of 116 patients, 36 (31 %) patients had a positive spot sign on their initial CTA. Mean (SD) time from symptom onset to CTA was 130.5 (84.0) min. Median (IQR) admission NIHSS in the spot-sign positive group was: 18 (12-24) and in the spot sign negative group: 12 (6-16.75); P<0.0001. The mean (SD) hematoma volume on admission was 64.1 mL (70.9) in the spot sign positive group and 23.0 mL (25.9) in the spot sign negative group (P<0.0001). The median (IQR) 3 months mRS was significantly different between group; Spot sign positive: 6 (4-6), Spot sign negative: 3 (2-4), P<0.0001. The spot sign independently predicted poor outcome (mRS 5-6) and death after 3 months (OR: 5.57, CI: 2.12-19.4) and (HR: 3.92, CI: 1.26-8.34). The Kaplan-Meier curve during the entire follow-up is displayed below and indicates significant different survival between groups (Tarone- Ware test: P<0.0001). Conclusion: No spot sign predicts a favorable spontaneous outcome after ICH.


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