Effects of induced arterial hypertension for vasospasm on unruptured and unsecured cerebral aneurysms (growth and rupture). A retrospective case-control study.

Objectives: Unruptured cerebral aneurysms (UCAs) often coexist with the ruptured one but are typically left unsecured during the weeks following aneurysmal subarachnoid hemorrhage (aSAH). We compared the rate of UCAs rupture or volume growth (≥5 mm ³ ) between patients exposed to induced arterial hypertension (iHTN) for vasospasm and those not exposed (control group).
Materials and Methods: From 2013 to 2021, we retrospectively included consecutive adult patients with aSAH who had ≥1 UCA. Custom software for digital subtraction angiography (DSA) image analysis characterized UCAs volume, going beyond merely considering UCAs long axis.
Results: We analyzed 118 patients (180 UCAs): 45 in the iHTN group (64 UCAs) and 73 in the control group (116 UCAs). Systolic blood pressure in the iHTN group was significantly higher than in the control group for several days after aSAH. During the 107 day-monitoring period [interquartile range(IQR):92;128], no UCA rupture occurred in either group. UCA volume analysis was performed in 44 patients (60 UCAs): none of the UCAs in the iHTN group and 3 out of 42 (7%) in the control group had a >5 mm ³ volume growth (p=0.55). Other morphologic parameters did not exhibit any variations that might indicate an increased risk of rupture in the iHTN group compared to the control group.
Conclusion: iHTN did not increase the risk of rupture or volume growth of UCAs within several weeks following aSAH. These reassuring results encourage not to refrain, because of the existence of UCAs, from iHTN as an option to prevent cerebral infarction during cerebral vasospasm.
Competing Interests: Declaration of competing interest Karim Lakhal has no conflict of interest in connection with the work submitted. In addition, KL received, during the past 3 years, congress registration from Pfizer (once in 2022) and both congress registration and travel fees from Advanz Pharma/Correvio (once in 2021) and AOP Health (once in 2024). Aude Missonnier has no conflict of interest in connection with the work submitted. Vincent L'Allinec has no conflict of interest in connection with the work submitted. Pacôme Constant dit Beaufils has no conflict of interest in connection with the work submitted. Florent Autrusseau has no conflict of interest in connection with the work submitted. Anass Nouri has no conflict of interest in connection with the work submitted. Matilde Karakachoff has no conflict of interest in connection with the work submitted. Bertrand Rozec has no conflict of interest in connection with the work submitted. Romain Bourcier has no conflict of interest in connection with the work submitted.
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