Cerebral Hemodynamics and Levosimendan Use in Patients with Cerebral Vasospasm and Subarachnoid Hemorrhage: An Observational Perfusion CT-Based Imaging Study.

Grégoire Cane, Hugues de Courson, Caroline Robert, Hikaru Fukutomi, Gaultier Marnat, Thomas Tourdias, Matthieu Biais
Neurocrit Care. 2024-02-07; :
DOI: 10.1007/s12028-023-01928-6

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Cane G(1), de Courson H(2), Robert C(2), Fukutomi H(3), Marnat G(4), Tourdias
T(4)(5), Biais M(2)(6).

Author information:
(1)Service d’Anesthésie-Réanimation Tripode, CHU de Bordeaux, Bordeaux, France.
(2)Service d’Anesthésie-Réanimation Tripode, CHU de Bordeaux, Bordeaux, France.
(3)Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University
Graduate School of Medicine, Kyoto, Japan.
(4)CHU de Bordeaux, Bordeaux, France.
(5)INSERM-U1215, Neurocentre Magendie, Bordeaux, France.
(6)INSERM Biologie des Maladies Cardiovasculaires U1034, University of Bordeaux,
33600, Pessac, France.

BACKGROUND: Delayed cerebral ischemia associated with cerebral vasospasm (CVS)
in aneurysmal subarachnoid hemorrhage significantly affects patient prognosis.
Levosimendan has emerged as a potential treatment, but clinical data are
lacking. The aim of this study is to decipher levosimendan’s effect on cerebral
hemodynamics by automated quantitative measurements of brain computed tomography
perfusion (CTP).
METHODS: We conducted a retrospective analysis of a database of a neurosurgical
intensive care unit. All patients admitted from January 2018 to July 2022 for
aneurysmal subarachnoid hemorrhage and treated with levosimendan for CVS who did
not respond to other therapies were included. Quantitative measurements of time
to maximum (Tmax), relative cerebral blood volume (rCBV), and relative cerebral
blood flow (rCBF) were automatically compared with coregistered CTP before and
after levosimendan administration in oligemic regions.
RESULTS: Of 21 patients included, CTP analysis could be performed in 16.
Levosimendan improved Tmax from 14.4 s (interquartile range [IQR] 9.1-21) before
treatment to 7.1 s (IQR 5.5-8.1) after treatment (p

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