ArticleCritical care (London, England)2025
The metabolic and autoregulatory profile of reversible delayed cerebral ischemia in unconscious patients after aneurysmal subarachnoid hemorrhage: a prospective multimodal neuromonitoring cohort study.
Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Invasive Monitoring of Cerebral Autoregulation in Aneurysmal Subarachnoid and Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.Diagnostics (Basel, Switzerland) · 2026Review
- Monitoring treatment of delayed cerebral ischaemia in unconscious patients after aneurysmal subarachnoid haemorrhage: a prospective multimodal neuromonitoring study.Stroke and vascular neurology · 2026Article
- Multimodal Monitoring Results Around Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage.Translational stroke research · 2026Article
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Authors and funding
13 authors.
Funding
Abstract
backgroundThe detection and treatment of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (SAH) remain challenging. Multimodal neuromonitoring and CT perfusion scanning (CTP) are promising tools for diagnosing DCI in unconscious patients. This study aims to compare the metabolic and autoregulatory characteristics of patients with cerebral hypoperfusion indicative of DCI that either resolves post-treatment or progresses to infarction due to treatment failure.
methodsIn a cohort of 268 consecutive SAH patients, neuromonitoring-comprising intracranial pressure (ICP) and brain tissue oxygen (PtiO
resultsCTP deficits were identified in 72 (57%) patients, of whom 63 (88%) had neuromonitoring probes near the affected areas. In 24 patients (38%), perfusion deficits progressed to infarction, while in 39 (62%), deficits were successfully reversed through induced hypertension or spasmolysis. In a GLMM, lower pressure reactivity index (PRx-OR 2.70, 95% CI 1.04-4.67; p < 0.001) and lower lactate-to-pyruvate ratio (LPR-OR 1.02, 95% CI 1.01-1.03; p < 0.001) were independently associated with better treatment response and reduced infarction risk, after adjusting for clinical hemorrhage severity. These effects were observed more than 24 h before cerebral hypoperfusion. Pooled PRx and LPR over this time frame were not associated with functional outcome.
conclusionLoss of cerebrovascular reactivity and metabolic disturbances precede cerebral hypoperfusion in SAH. Lower PRx and LPR levels are independently associated with improved DCI treatment efficacy. These findings must be interpreted in the context of study limitations, including the small sample size and the focal nature of microdialysis measurements. Nevertheless, the results suggest that invasive neuromonitoring may aid in identifying patients more likely to benefit from treatment.
trial registrationThis project was retrospectivly registered in the German Clinical Trial Register (DRKS00030505) on the third of January 2023.
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