By Dr Linxin Li
ESOC 2023 Session Report – SAH and ICH
After the presentations of two positive trials in ICH in the plenary session, the excitement continued in the scientific communication session on ICH this afternoon.
We had a range of high quality studies presented, including randomised controlled trials, individual participant level meta-analysis and hospital as well as population-based cohorts, focusing also on various aspects of ICH management. Here are some of the highlights.
Dr Iain McGurgan presented the results from the Prevention Of Hypertensive Injury to the Brain by Intensive Treatment of blood pressure after IntraCerebral Haemorrhage (PROHIBIT-ICH) trial, which is a randomized trial assessing home telemetry-guided blood pressure treatment in ICH. They demonstrated that centralized home blood pressure monitoring was feasible with excellent patient acceptance. It also resulted in better blood pressure control at 3 months than routine care with a significant group difference of 13.6 mmHg. We look forward to hearing the long-term blood pressure control and imaging marker related results in the near future.
Professor Philip Bath and Dr Shoujiang You presented results using data from the Blood Pressure in Acute Stroke Collaboration (BASC). It was very interesting to see advances in statistical methods to allow the use of a global analysis approach to assess outcomes. On the other hand, this large ICH dataset also made it possible to provide more reliable data showing that there were greater rates of early neurological deterioration in lobar ICH compared to deep ICH, yet after adjustment for baseline ICH volume, deep ICH location was associated with poorer functional outcome at 90 days.
Dr David Rodriguez-Luna used data from the RAINS study and showed that achievement of systolic blood pressure target of <140 mmHg within 60min after hospital arrival was associated with lower rate of substantial hematoma expansion and early neurological deterioration, resulting in better function outcomes. This highlights that “time is brain” also holds true for ICH. We also heard from Dr Bernhard Siepen that there has been a change with regards to the spectrum of anticoagulation-associated ICH in the last decade with a shift towards more DOAC-related ICH. Somewhat reasurringly, the outcome of DOAC-related ICH seemed more comparable to non-anticoagulated ICH.
Finally the session concluded from a promising score to predict death after ICH presented by Dr Baptiste Alvarez and an interesting finding of an association of CAA and SDH presented by Dr Cyprien Rivier.