{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:57:17Z","timestamp":1792173437424,"version":"4.4.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Rescue treatment for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage can include induced hypertension (iHTN) and, in refractory cases, endovascular approaches, of which selective, continuous intraarterial nimodipine (IAN) is one variant. The combination of iHTN and IAN can dramatically increase vasopressor demand. In case of unsustainable doses, iHTN is often prioritized over IAN. However, evidence in this regard is largely lacking. We investigated the effects of a classical (iHTN+IAN) and modified (IAN\n                      <jats:sub>only<\/jats:sub>\n                      ) treatment protocol for refractory DCI in an observational study.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Rescue treatment for DCI was initiated with iHTN (target &gt;180 mm\u2009Hg systolic) and escalated to IAN in refractory cases. Until July 2018, both iHTN and IAN were offered in cases refractory to iHTN alone. After protocol modification, iHTN target was preemptively lowered to &gt;120 mm\u2009Hg when IAN was initiated (IAN\n                      <jats:sub>only<\/jats:sub>\n                      ). Primary outcome was noradrenaline demand. Secondary outcomes included noradrenaline-associated complications, brain tissue oxygenation, DCI-related infarction and favorable 6-month outcome (Glasgow Outcome Scale 4\u20135).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      N=29 and n=20 patients were treated according to the classical and modified protocol, respectively. Protocol modification resulted in a significant reduction of noradrenaline demand (iHTN+IAN 0.70\u00b10.54 \u00b5g\/kg per minute and IAN\n                      <jats:sub>only<\/jats:sub>\n                      0.26\u00b10.20 \u00b5g\/kg per minute,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001) and minor complications (15.0% versus 48.3%, unadjusted odds ratio, 0.19 [95% CI, 0.05\u20130.79];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05) with comparable rates of major complications (20.0% versus 20.7%, odds ratio, 0.96 [0.23\u20133.95];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.95). Incidence of DCI-related infarction (45.0% versus 41.1%, odds ratio, 1.16 [0.37\u20133.66];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.80) and favorable clinical outcome (55.6% versus 40.0%, odds ratio, 1.88 [0.55\u20136.39];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.32) were similar. Brain tissue oxygenation was significantly higher with IANonly (26.6\u00b112.8, 39.6\u00b115.4 mm\u2009Hg;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Assuming the potential of iHTN to be exhausted in case of refractory hypoperfusion, additional IAN may serve as a last-resort measure to bridge hypoperfusion in the DCI phase. With close monitoring, preemptive lowering of pressure target after induction of IAN may be a safe alternative to alleviate total noradrenaline load and potentially reduce complication rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.121.038216","type":"journal-article","created":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T05:00:16Z","timestamp":1654664416000},"page":"2607-2616","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Intraarterial Nimodipine Versus Induced Hypertension for Delayed Cerebral Ischemia: A Modified Treatment Protocol"],"prefix":"10.1161","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8820-0805","authenticated-orcid":true,"given":"Miriam","family":"Weiss","sequence":"first","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."},{"name":"Department of Neurosurgery, Kantonsspital Aarau, Switzerland (M.W., G.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid","family":"Albanna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9979-5947","authenticated-orcid":true,"given":"Catharina","family":"Conzen-Dilger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Kastenholz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Seyfried","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5195-614X","authenticated-orcid":true,"given":"Hani","family":"Ridwan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology (H.R., M.W.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8261-5513","authenticated-orcid":true,"given":"Martin","family":"Wiesmann","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology (H.R., M.W.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3648-6842","authenticated-orcid":true,"given":"Michael","family":"Veldeman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6293-0025","authenticated-orcid":true,"given":"Tobias Philip","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7613-6444","authenticated-orcid":true,"given":"Murad","family":"Megjhani","sequence":"additional","affiliation":[{"name":"Program for Hospital and Intensive Care Informatics, Department of Neurology (M.M., S.P.), Columbia University Irving Medical Center, NY."},{"name":"NewYork Presbyterian Hospital (M.M., S.P.), Columbia University Irving Medical Center, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henna","family":"Schulze-Steinen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine and Perioperative Care (H.S.-S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8258-9346","authenticated-orcid":true,"given":"Hans","family":"Clusmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (M.W., W.A., C.C.-D., N.K., K.S., M.V., T.P.S., H.C., G.A.S.), RWTH Aachen University, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5327-1275","authenticated-orcid":true,"given":"Marinus Johannes Hermanus","family":"Aries","sequence":"additional","affiliation":[{"name":"Department 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