{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:57:28Z","timestamp":1792173448488,"version":"4.4.0"},"reference-count":31,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"crossref","award":["210839\/225270"],"award-info":[{"award-number":["210839\/225270"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["VE 1274\/1-2"],"award-info":[{"award-number":["VE 1274\/1-2"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Stroke Vasc Neurol"],"accepted":{"date-parts":[[2025,10,11]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Aneurysmal subarachnoid haemorrhage (SAH) is a life-threatening condition with high morbidity. Delayed cerebral ischaemia (DCI) significantly contributes to secondary injury and poor outcomes. While perfusion CT (CTP) aids DCI detection, multimodal neuromonitoring\u2014including brain tissue oxygenation (PtiO\n                      <jats:sub>2<\/jats:sub>\n                      ) and cerebral microdialysis\u2014offers superior temporal resolution. Its value in guiding treatment remains underexplored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included SAH patients monitored with multimodal neuromonitoring at RWTH Aachen University Hospital (2014\u20132020). DCI was diagnosed with neuromonitoring abnormalities and confirmed by CTP. First-line treatment involved induced hypertension, with endovascular rescue treatment for refractory cases. Physiological data were time-aligned to treatment onset and aggregated into hourly summaries. Binomial logistic regression identified predictors of favourable 1-year outcome (modified Rankin Scale 0\u20133).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 56 patients with confirmed DCI, correctly placed probes and available outcome data, 22 (39.3%) achieved favourable outcome. These patients showed greater post-treatment reductions in pressure reactivity index (PRx) and lactate-to-pyruvate ratio (LPR). In multivariable analysis, greater PRx reduction was significantly associated with favourable outcome (OR 0.023, 95%\u2009CI 0.001 to 0.394, p=0.009), translating to a 46.5% increase in odds per 0.1-unit decrease. Greater LPR reductions were also predictive (OR 0.950, 95%\u2009CI 0.904 to 0.998, p=0.042), with a 5-unit drop linked to a 29.3% increase in odds. Although PtiO2\n                      <jats:sub>\u2082<\/jats:sub>\n                      improved post-treatment, it was not associated with outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PRx and LPR reflect meaningful physiological responses to DCI treatment and are associated with 1-year outcomes. Multimodal neuromonitoring may support not only diagnosis but also treatment monitoring and decision-making in unconscious SAH patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>German Clinical Trial Registry (DRKS00030505).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/svn-2025-004642","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:50:33Z","timestamp":1762325433000},"page":"422-433","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Monitoring treatment of delayed cerebral ischaemia in unconscious patients after aneurysmal subarachnoid haemorrhage: a prospective multimodal neuromonitoring study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3648-6842","authenticated-orcid":false,"given":"Michael","family":"Veldeman","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, RWTH Aachen University, Aachen, Germany"},{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan Yu","family":"B\u00f6gli","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"},{"name":"Department of Neurology, University of Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8283-305X","authenticated-orcid":false,"given":"Ihsane","family":"Olakorede","sequence":"additional","affiliation":[{"name":"University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Kastenholz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, RWTH Aachen University, Aachen, Germany"},{"name":"Department of Neurosurgery, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland"},{"name":"University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catharina","family":"Conzen-Dilger","sequence":"additional","affiliation":[{"name":"RWTH Aachen University, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina Sophie","family":"Seyfried","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, RWTH Aachen University, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erta","family":"Beqiri","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte S","family":"Weyland","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Clusmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, RWTH Aachen University, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerrit A","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, RWTH Aachen University, Aachen, Germany"},{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke","family":"Hoellig","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, RWTH Aachen University, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Smielewski","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2026082702101067000_11.4.422.1","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1001\/jamaneurol.2019.0006","article-title":"Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis","volume":"76","author":"Etminan","year":"2019","journal-title":"JAMA Neurol"},{"key":"2026082702101067000_11.4.422.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00938-2"},{"key":"2026082702101067000_11.4.422.3","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.586826"},{"key":"2026082702101067000_11.4.422.4","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1212\/WNL.45.5.871","article-title":"Sudden death from aneurysmal subarachnoid hemorrhage","volume":"45","author":"Schievink","year":"1995","journal-title":"Neurology (ECronicon)"},{"key":"2026082702101067000_11.4.422.5","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.021845","article-title":"Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review","volume":"10","author":"Dodd","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2026082702101067000_11.4.422.6","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2013.246"},{"key":"2026082702101067000_11.4.422.7","doi-asserted-by":"publisher","DOI":"10.1038\/jcbfm.2011.56"},{"key":"2026082702101067000_11.4.422.8","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3787"},{"key":"2026082702101067000_11.4.422.9","doi-asserted-by":"crossref","DOI":"10.3389\/fradi.2024.1445676","article-title":"CT perfusion imaging in aneurysmal subarachnoid hemorrhage. State of the art","volume":"4","author":"Lolli","year":"2024","journal-title":"Front Radiol"},{"key":"2026082702101067000_11.4.422.10","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1007\/s12028-023-01855-6","article-title":"Perfusion Computed Tomography as a Screening Tool for Pending Delayed Cerebral Ischemia in Comatose Patients After Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study","volume":"40","author":"Busse","year":"2024","journal-title":"Neurocrit Care"},{"key":"2026082702101067000_11.4.422.11","doi-asserted-by":"crossref","first-page":"3624","DOI":"10.1161\/STROKEAHA.121.034633","article-title":"Invasive Multimodal Neuromonitoring in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review","volume":"52","author":"Veldeman","year":"2021","journal-title":"Stroke"},{"key":"2026082702101067000_11.4.422.12","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.3171\/2020.3.JNS20375","article-title":"Invasive neuromonitoring with an extended definition of delayed cerebral ischemia is associated with improved outcome after poor-grade subarachnoid hemorrhage","volume":"134","author":"Veldeman","year":"2021","journal-title":"J Neurosurg"},{"key":"2026082702101067000_11.4.422.13","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017956"},{"key":"2026082702101067000_11.4.422.14","doi-asserted-by":"crossref","first-page":"2630","DOI":"10.1161\/STROKEAHA.118.022310","article-title":"Induced Hypertension in Preventing Cerebral Infarction in Delayed Cerebral Ischemia After Subarachnoid Hemorrhage","volume":"49","author":"Haegens","year":"2018","journal-title":"Stroke"},{"key":"2026082702101067000_11.4.422.15","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1136\/jnis-2023-021151","article-title":"Intra-arterial nimodipine for the treatment of refractory delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage","volume":"17","author":"Vossen","year":"2024","journal-title":"J Neurointerv Surg"},{"key":"2026082702101067000_11.4.422.16","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-023-04452-3","article-title":"The oxygen reactivity index indicates disturbed local perfusion regulation after aneurysmal subarachnoid hemorrhage: an observational cohort study","volume":"27","author":"Kastenholz","year":"2023","journal-title":"Crit Care"},{"key":"2026082702101067000_11.4.422.17","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.040339"},{"key":"2026082702101067000_11.4.422.18","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1093\/neuros\/nyw132","article-title":"Endovascular Rescue Therapies for Refractory Vasospasm After Subarachnoid Hemorrhage: A Prospective Evaluation Study Using Multimodal, Continuous Event Neuromonitoring","volume":"80","author":"Albanna","year":"2017","journal-title":"Neurosurgery"},{"key":"2026082702101067000_11.4.422.19","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2019.00136","article-title":"Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective","volume":"10","author":"Weiss","year":"2019","journal-title":"Front Neurol"},{"key":"2026082702101067000_11.4.422.20","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-025-05460-1","article-title":"The metabolic and autoregulatory profile of reversible delayed cerebral ischemia in unconscious patients after aneurysmal subarachnoid hemorrhage: a prospective multimodal neuromonitoring cohort study","volume":"29","author":"Veldeman","year":"2025","journal-title":"Crit Care"},{"key":"2026082702101067000_11.4.422.21","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1007\/s12028-020-01169-x","article-title":"Treatment of Delayed Cerebral Ischemia in Good-Grade Subarachnoid Hemorrhage: Any Role for Invasive Neuromonitoring?","volume":"35","author":"Veldeman","year":"2021","journal-title":"Neurocrit Care"},{"key":"2026082702101067000_11.4.422.22","first-page":"095","article-title":"24 Hour Glasgow Coma Scale and Its Components Are Better Predictors of Outcome Than Initial GCS Score in Spontaneous Intracerebral Hemorrhage (P04.095)","volume":"80","author":"Mehta","year":"2013","journal-title":"Neurology (ECronicon)"},{"key":"2026082702101067000_11.4.422.23","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1988.68.6.0985"},{"key":"2026082702101067000_11.4.422.24","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000218821.34014.1B"},{"key":"2026082702101067000_11.4.422.25","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.574392"},{"key":"2026082702101067000_11.4.422.26","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1001\/jamaneurol.2023.1792","article-title":"Effectiveness of Lumbar Cerebrospinal Fluid Drain Among Patients With Aneurysmal Subarachnoid Hemorrhage: A Randomized Clinical Trial","volume":"80","author":"Wolf","year":"2023","journal-title":"JAMA Neurol"},{"key":"2026082702101067000_11.4.422.27","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.19.5.604"},{"key":"2026082702101067000_11.4.422.28","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199707000-00005"},{"key":"2026082702101067000_11.4.422.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02237-6"},{"key":"2026082702101067000_11.4.422.30","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000209607","article-title":"Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage: Location, Distribution Patterns, Infarct Load, and Effect on Outcome","volume":"103","author":"Veldeman","year":"2024","journal-title":"Neurology (ECronicon)"},{"key":"2026082702101067000_11.4.422.31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"}],"container-title":["Stroke and Vascular Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/svn-2025-004642","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:11:14Z","timestamp":1787821874000},"score":1,"resource":{"primary":{"URL":"https:\/\/svn.bmj.com\/lookup\/doi\/10.1136\/svn-2025-004642"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,4]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8,27]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/svn-2025-004642"],"URL":"https:\/\/doi.org\/10.1136\/svn-2025-004642","relation":{},"ISSN":["2059-8688","2059-8696"],"issn-type":[{"value":"2059-8688","type":"print"},{"value":"2059-8696","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,4]]}}}