title: Unsecured intracranial aneurysms and induced hypertension in cerebral vasospasm: is induced hypertension safe?
abstract: BACKGROUND
  Induced hypertension is an established therapy to treat cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH) to prevent delayed ischemic deficits. Currently, there is minimal evidence available assessing the risk of induced hypertension in the presence of unsecured aneurysms. The aim of this study was to investigate the impact of induced hypertension on the rupturing of unsecured aneurysms in treating CVS.
  
  
  METHODS
  We conducted a retrospective analysis between 1999 and 2009. Patients with unsecured aneurysms treated with induced hypertension were identified and stratified as having (1) additional unruptured unsecured aneurysms or (2) ruptured unsecured aneurysms. Hemodynamic parameters were analyzed and any bleeding recorded.
  
  
  RESULTS
  Forty-five patients were included. Of those, 41 had 71 additional unruptured unsecured aneurysms and four patients had four ruptured unsecured aneurysms. The mean size of unsecured aneurysms was: 4.0 ± 1.9 mm (additional unruptured) and 5.3 ± 2.2 mm (ruptured), respectively. No aneurysm ruptured during therapy. Combining our data with previously published studies, there appears to be no increase of risk for aneurysm rupture by induced hypertension when compared to the natural history (0.5% for group 1, 2.9% for group 2).
  
  
  CONCLUSIONS
  These data corroborate that induced hypertension may be a safe treatment option to prevent cerebral infarction in CVS, even in the presence of unsecured aneurysms. Our findings suggest that induced hypertension does not increase rupture of unsecured aneurysms. Given the high risk for cerebral infarction in severe CVS, we conclude that induced hypertension should not be omitted due to the presence of unsecured aneurysms.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt Am Main, Germany. susan.wieting@insel.ch
authors.forename: Johannes
authors.initials: J
authors.lastname: Platz
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D001810:Blood Volume / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004280:Dobutamine / Q000009:adverse effects; D004298:Dopamine / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D020896:Hypovolemia / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D013566:Sympathomimetics / Q000009:adverse effects; D020301:Vasospasm, Intracranial / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D013566:Sympathomimetics; D004280:Dobutamine; D004298:Dopamine; D009638:Norepinephrine