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All Journal Journal of Neurointervention and Stroke (JNeViS)
Faishol Hamdani
Department of Neurology, Bangil General Hospital, Pasuruan
Medicine & Pharmacology Neuroscience

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The Impact of Elevated Mean Arterial Pressure on Mortality in Spontaneous Subarachnoid Hemorrhage Achmad Firdaus Sani; Taurus Laisari; Muh. Wildan Yahya; Vita Kusuma Rahmawati; Faishol Hamdani; Dedy Kurniawan; Sita Setyowatie
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.2

Abstract

Highlight: Elevated MAP is associated with increased in-hospital mortality in SAH patients High MAP increases the risk of rebleeding, cerebral edema, and vasospasm MAP, age, infection, and hydrocephalus are independent predictors of mortality ABSTRACT Introduction: Subarachnoid hemorrhage (SAH) remains a critical neurological emergency with high mortality and morbidity. Mean arterial pressure (MAP) plays an importance role in cerebral perfusion and hemodynamic stability in SAH patients. However, excessive MAP elevation potentially worsening clinical outcomes. This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients. Objective: This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients.  Method: A retrospective cross-sectional study was conducted using medical records of SAH patients admitted to Dr. Soetomo Academic Medical Center Hospital from 2013 to 2021. A total of 360 patients met the inclusion criteria. MAP was calculated upon admission and categorized as ≥125 mmHg or <125 mmHg. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to assess the association between MAP and mortality while adjusting for confounders. Result: Among 360 SAH patients, 44.8% did not survive hospitalization. The mean age was 54 years, with an initial mean MAP of 117.45±21.6 mmHg. Bivariate analysis showed that MAP ≥125 mmHg significantly increased mortality risk (OR = 1.93; 95% CI: 1.24–2.98; p = 0.002). Multivariate logistic regression identified MAP ≥125 mmHg as an independent predictor of mortality (Adjusted OR = 1.795; p = 0.012), alongside age (Adjusted OR = 2.043; p = 0.004), infection (Adjusted OR = 2.442; p = 0.001), and hydrocephalus (Adjusted OR = 2.174; p = 0.003). Conclusion: Elevated MAP (≥125 mmHg) is significantly associated with increased in-hospital mortality in SAH patients. These findings highlight the importance of early hemodynamic management in SAH to improve patient survival.
Deferring Angioplasty and Stenting based on Natural Progression in Severe Middle Cerebral Artery Stenosis: An Observation of Two Cases Vita Kusuma Rahmawati; Achmad Firdaus Sani; Dedy Kurniawan; Muh. Wildan Yahya; Faishol Hamdani
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.5

Abstract

Highlight: MCA stenosis may remodel spontaneously or progress to complete occlusion Serial imaging observing progression spots high-risk cases, guiding intervention ABSTRACT Introduction: Severe middle cerebral artery (MCA) stenosis, as one of the intracranial atherosclerotic diseases, is a major cause of ischemic stroke. The role and optimal timing of interventions, such as angioplasty and stenting, remain subjects of debate, particularly due to the variable natural disease progression. While some cases improve spontaneously, others progress to total occlusion, necessitating comprehensive evaluation of individualized treatment approaches. Cases: This case series presents two patients with severe MCA stenosis, each of whom followed a distinct clinical courses. The first patient had 88% stenosis in the M1 segment of the right MCA (NIHSS 3, mRS 2), which spontaneously improved to 57% within days (NIHSS 2, mRS 2), with enhanced distal flow, leading to the decision to defer angioplasty and stenting. In contrast, the second patient initially had severe left MCA stenosis (NIHSS 10, mRS 4), which progressed to total occlusion within three months (NIHSS 10, mRS 4), also resulting in deferred intervention. Serial cerebral digital subtraction angiography (DSA) facilitated the observation of vascular evolution and collateral circulation, guiding decisions about intervention. Conclusion: The clinical outcomes of MCA stenosis range widely, from spontaneous resolution to progressive occlusion. Close serial imaging observation of collateral circulation and natural progression is essential for guiding decisions about angioplasty and stenting.  
Co-Authors Achmad Firdaus Sani Dedy Kurniawan Muh. Wildan Yahya Sita Setyowatie Taurus Laisari Vita Kusuma Rahmawati