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Cerebral Hemodynamics and Levosimendan Use in Patients with Cerebral Vasospasm and Subarachnoid Hemorrhage: An Observational Perfusion CT-Based Imaging Study.

dc.rights.licenseopenen_US
hal.structure.identifierUniversité de Bordeaux [UB]
hal.structure.identifierService Anesthésie - Réanimation [Bordeaux]
dc.contributor.authorCANE, Gregoire
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorDE COURSON, Hugues
dc.contributor.authorROBERT, Caroline
dc.contributor.authorFUKUTOMI, Hikaru
dc.contributor.authorMARNAT, Gaultier
hal.structure.identifierNeurocentre Magendie : Physiopathologie de la Plasticité Neuronale [U1215 Inserm - UB]
dc.contributor.authorTOURDIAS, Thomas
hal.structure.identifierBiologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases
dc.contributor.authorBIAIS, Matthieu
dc.date.accessioned2024-03-25T15:48:58Z
dc.date.available2024-03-25T15:48:58Z
dc.date.issued2024-02-07
dc.identifier.issn1556-0961en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/188967
dc.description.abstractEnDelayed cerebral ischemia associated with cerebral vasospasm (CVS) in aneurysmal subarachnoid hemorrhage significantly affects patient prognosis. Levosimendan has emerged as a potential treatment, but clinical data are lacking. The aim of this study is to decipher levosimendan's effect on cerebral hemodynamics by automated quantitative measurements of brain computed tomography perfusion (CTP). We conducted a retrospective analysis of a database of a neurosurgical intensive care unit. All patients admitted from January 2018 to July 2022 for aneurysmal subarachnoid hemorrhage and treated with levosimendan for CVS who did not respond to other therapies were included. Quantitative measurements of time to maximum (Tmax), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) were automatically compared with coregistered CTP before and after levosimendan administration in oligemic regions. Of 21 patients included, CTP analysis could be performed in 16. Levosimendan improved Tmax from 14.4 s (interquartile range [IQR] 9.1-21) before treatment to 7.1 s (IQR 5.5-8.1) after treatment (p < 0.001). rCBV (94% [IQR 79-103] before treatment and 89% [IQR 72-103] after treatment, p = 0.63) and rCBF (85% [IQR 77-90] before treatment and 87% [IQR 73-98] after treatment, p = 0.98) remained stable. The subgroup of six patients who did not develop cerebral infarction attributed to delayed cerebral ischemia showed an approximately 10% increase (rCBV 85% [IQR 79-99] before treatment vs. 95% [IQR 88-112] after treatment, p = 0.21; rCBF 81% [IQR 76-87] before treatment vs. 89% [IQR 84-99] after treatment, p = 0.4). In refractory CVS, levosimendan use was associated with a significant reduction in Tmax in oligemic regions. However, this value remained at an abnormal level, indicating the presence of a persistent CVS. Further analysis raised the hypothesis that levosimendan causes cerebral vasodilation, but other studies are needed because our design does not allow us to quantify the effect of levosimendan from that of the natural evolution of CVS.
dc.language.isoENen_US
dc.subject.enCerebral infarction; Intracranial aneurysm; Levosimendan; Perfusion imaging; Subarachnoid hemorrhage
dc.title.enCerebral Hemodynamics and Levosimendan Use in Patients with Cerebral Vasospasm and Subarachnoid Hemorrhage: An Observational Perfusion CT-Based Imaging Study.
dc.title.alternativeNeurocrit Careen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1007/s12028-023-01928-6en_US
dc.subject.halSciences du Vivant [q-bio]/Médecine humaine et pathologieen_US
dc.identifier.pubmed38326535en_US
bordeaux.journalNeurocritical Careen_US
bordeaux.hal.laboratoriesBiologie des maladies cardiovasculaires (BMC) - UMR 1034en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.import.sourcepubmed
hal.identifierhal-04520520
hal.version1
hal.date.transferred2024-03-25T15:49:00Z
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exporttrue
workflow.import.sourcepubmed
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&amp;rft_val_fmt=info:ofi/fmt:kev:mtx:journal&amp;rft.jtitle=Neurocritical%20Care&amp;rft.date=2024-02-07&amp;rft.eissn=1556-0961&amp;rft.issn=1556-0961&amp;rft.au=CANE,%20Gregoire&amp;DE%20COURSON,%20Hugues&amp;ROBERT,%20Caroline&amp;FUKUTOMI,%20Hikaru&amp;MARNAT,%20Gaultier&amp;rft.genre=article


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