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Randomized Controlled Trial
. 2017 Jun;96(26):e7289.
doi: 10.1097/MD.0000000000007289.

Antihypertensive treatments for spontaneous intracerebral hemorrhage in patients with cerebrovascular stenosis: A randomized clinical trial (ATICHST)

Zengpanpan Ye  1 , Xiaolin Ai, Jun Zheng, Xin Hu, Sen Lin, Chao You, Hao Li
Affiliations
Randomized Controlled Trial

Antihypertensive treatments for spontaneous intracerebral hemorrhage in patients with cerebrovascular stenosis: A randomized clinical trial (ATICHST)

Zengpanpan Ye et al. Medicine (Baltimore). 2017 Jun.

Abstract

Introduction: Antihypertensive treatment is associated with clinical outcomes in patients with spontaneous intracerebral hemorrhage (sICH). ADAPT showed that intensive blood pressure lowering (<140 mm Hg) does not reduce peri-hematoma regional cerebral blood flow (rCBF) in patients with sICH. However, the stenosis of main cerebral arteries that has a high presence in patients with sICH is well-known related to the brain ischemia. The effect of intensive BP lowering for sICH in patients with cerebrovascular stenosis is still unknown.

Aim: The aim of this study was to determine the safety and effectiveness of intensive BP lowering for sICH in patients with cerebrovascular stenosis.

Methods and analysis: A pilot trial has been conducted to calculate the sample size and 80 patients of sICH with cerebrovascular stenosis will be involved. The target of systolic blood pressure (SBP) will be maintained at from 120 to 140 mm Hg or from 140 to 180 mm Hg for 7 days. Cerebral ischemia will be assessed at 24 hours after onset by computed tomography (CT) perfusion imaging and the follow-up will be conducted at 30-day and 90-day. The primary outcome is the reduction of peri-hematoma rCBF. The other cerebral perfusion indexes and the rate of ischemic stroke are regarded as other primary outcomes. The secondary outcomes include clinical outcome at 30 days and 90 days, complications, and hospital stays.

Discussion: The ATICHST trial has been signed as a parallel, prospective, randomized, assessor-blinded clinical trial to determine the effects of intensive BP lowering on sICH in patients with cerebrovascular stenosis, the results of which will contribute to guide the management of blood pressure in sICH.

Conclusion: The protocol will determine the safety and effectiveness of intensive BP lowering for sICH with cerebrovascular stenosis.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the clinical trial. CTA = CT angiography, NCCT = noncontrast CT, SBP = systolic blood pressure, sICH = spontaneous intracerebral hemorrhage.
Figure 2
Figure 2
A 58-year-old female was diagnosed with right basal ganglion hemorrhage by NCCT (A). CTA (B) and DSA (C) identified the 62% stenosis of right internal carotid artery with white arrow. The CTP showed the mean CBF of perihematoma (20.24 mL/100 mL/min) and contralateral homologous region (48.05 mL/100 mL/min).
See this image and copyright information in PMC

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