Intensive Blood Pressure Reduction and Spot Sign in Intracerebral Hemorrhage Interview with:
Andrea Morotti, M.D.
Research Fellow in Neurology
Massachusetts General Hospital
Harvard Medical School What is the background for this study? What are the main findings?

Response: The CT angiography (CTA) spot sign is a validated marker of Intracerebral Hemorrhage (ICH) expansion and may identify those subjects more likely to benefit from intensive blood pressure reduction.

We observed that less than 20% of ICH patients received a CTA as part of their diagnostic workup in a large, international randomized clinical trial. The performance of the spot sign in predicting ICH growth was suboptimal compared with what was reported in previous studies. Intensive blood pressure reduction did not improve functional outcome in spot sign positive patients. What should clinicians and patients take away from your report?

Response: Few ICH patients underwent a CTA and there is great variability in the CTA acquisition protocol across different institutions.

There is no evidence that spot sign positive patients benefit from intensive blood pressure treatment. What recommendations do you have for future research as a result of this study?

Response: Standardization of the CTA acquisition protocol for spot sign detection is needed.

Non-contrast CT markers of ICH expansion have been recently reported. These NCCT signs may be a reliable alternative to the CTA spot sign for hematoma expansion prediction in clinical practice or in the setting of future randomized clinical trials. Thank you for your contribution to the community.

Citation: JAMA

Morotti A, Brouwers HB, Romero JM, Jessel MJ, Vashkevich A, Schwab K, Afzal MR, Cassarly C, Greenberg SM, Martin RH, Qureshi AI, Rosand J, Goldstein JN, for the Antihypertensive Treatment of Acute Cerebral Hemorrhage II and Neurological Emergencies Treatment Trials Investigators. Intensive Blood Pressure Reduction and Spot Sign in Intracerebral HemorrhageA Secondary Analysis of a Randomized Clinical Trial. JAMA Neurol. Published online June 19, 2017. doi:10.1001/jamaneurol.2017.1014

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Last Updated on June 22, 2017 by Marie Benz MD FAAD