EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

IC BAILEY; JA LYTTLE; B MATTHEW; G BRAADVEDT; RJ NELSON; G STRANJALIS; JP CASTEL; JM ORGOGOZO; AM AZIZ; TF BUCKLEY; RG GALVIN; A KESHTGAR; JC MARKS; J HUTCHISON; SA OLAOIRE; J SINGH; JD MILLER; GD MURRAY; I. BONE; GM TEASDALE; D GROSSET; P FOY; PRD HUMPHREY; K MORRIS; MDM SHAW; BA BELL; FG JOHNSTON; S. R. STAPLETON; WAS TAYLOR; J.R. BARTLETT; D DORRANCE; RW GULLAN; IJA ROBERTSON; L CALANDRE; RD LOBATO; M BARNES; U CHOKSEY; JA COZENS; J MCMAHON; AD MENDELOW; DT HOPE; D JEFFERSON; B WHITE; Y KEREVAL; D MOHAN; PS DIAS; S HOWELL; J JAKUBOWSKI; B MARTIN; J MARTIN; JD PICKARD; J STANLEY; J LAGARRIGUE; V LARRUE; OP DAHL; R JUUL

EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

IC BAILEY, JA LYTTLE, B MATTHEW, G BRAADVEDT, RJ NELSON, G STRANJALIS, JP CASTEL, JM ORGOGOZO, AM AZIZ, TF BUCKLEY, RG GALVIN, A KESHTGAR, JC MARKS, J HUTCHISON, SA OLAOIRE, J SINGH, JD MILLER, GD MURRAY, I. BONE, GM TEASDALED GROSSET, P FOY, PRD HUMPHREY, K MORRIS, MDM SHAW, BA BELL, FG JOHNSTON, S. R. STAPLETON, WAS TAYLOR, J.R. BARTLETT, D DORRANCE, RW GULLAN, IJA ROBERTSON, L CALANDRE, RD LOBATO, M BARNES, U CHOKSEY, JA COZENS, J MCMAHON, AD MENDELOW, DT HOPE, D JEFFERSON, B WHITE, Y KEREVAL, D MOHAN, PS DIAS, S HOWELL, J JAKUBOWSKI, B MARTIN, J MARTIN, JD PICKARD, J STANLEY, J LAGARRIGUE, V LARRUE, OP DAHL, R JUUL

School of Population Health Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

The finding that the carotid vascular beds are sensitive to the potent vasodilator calcitonin-gene-related peptide (CGRP) suggested that the drug might help to prevent ischaemic deterioration after surgery for aneurysmal subarachnoid haemorrhage (SAH). The results of a preliminary study were encouraging, so we have carried out a randomised multicentre single-blind comparison of CGRP and standard best management in patients with ischaemic deficits after surgery for ruptured intracranial aneurysms.

Patients aged 18-70 years in whom a focal neurological deficit developed or who had a reduction of 2 or more points on the Glasgow coma scale (GCS) after surgery entered the study after computed tomography had excluded non-ischaemic causes for the neurological deficit. 62 patients were randomly assigned an infusion of 0.6-mu-g/min CGRP for 4 h, then up to a maximum of 10 days, and 55 patients standard best management (controls). GCS and haemodynamic variables were assessed during the hospital stay, and all patients were followed up at 3 months by an independent investigator, who was unaware of their treatment. Outcome, measured on the Glasgow outcome scale, at 3 months was good in 66% of those treated with CGRP and 60% in the controls; the relative risk of a poor outcome in CGRP-treated patients was 0.88 (95% confidence interval 0.60 to 1.28). Hypotension was a common side-effect of the CGRP infusion. 66% of the CGRP group did not complete treatment because of adverse events (19 patients), lack of improvement at 4 h (17 patients) or later (4 patients), or patient's request (1 patient).

Although we could not show a significant beneficial effect of CGRP in this trial, the wide confidence interval for the risk of a poor outcome and the fact that only a third of patients completed treatment mean that a clinically useful benefit cannot yet be ruled out.

Original language	English
Pages (from-to)	831-834
Number of pages	4
Journal	The Lancet
Volume	339
Issue number	8797
Publication status	Published - 4 Apr 1992

Keywords / Materials (for Non-textual outputs)

NERVE-FIBERS
HEMORRHAGE
VOLUNTEERS
CGRP

Cite this

BAILEY, IC., LYTTLE, JA., MATTHEW, B., BRAADVEDT, G., NELSON, RJ., STRANJALIS, G., CASTEL, JP., ORGOGOZO, JM., AZIZ, AM., BUCKLEY, TF., GALVIN, RG., KESHTGAR, A., MARKS, JC., HUTCHISON, J., OLAOIRE, SA., SINGH, J., MILLER, JD., MURRAY, GD., BONE, I., ... JUUL, R. (1992). EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE. The Lancet, 339(8797), 831-834.

@article{7890ffd7a4354d47809fdedcb1b2f7a0,

title = "EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE",

abstract = "The finding that the carotid vascular beds are sensitive to the potent vasodilator calcitonin-gene-related peptide (CGRP) suggested that the drug might help to prevent ischaemic deterioration after surgery for aneurysmal subarachnoid haemorrhage (SAH). The results of a preliminary study were encouraging, so we have carried out a randomised multicentre single-blind comparison of CGRP and standard best management in patients with ischaemic deficits after surgery for ruptured intracranial aneurysms.Patients aged 18-70 years in whom a focal neurological deficit developed or who had a reduction of 2 or more points on the Glasgow coma scale (GCS) after surgery entered the study after computed tomography had excluded non-ischaemic causes for the neurological deficit. 62 patients were randomly assigned an infusion of 0.6-mu-g/min CGRP for 4 h, then up to a maximum of 10 days, and 55 patients standard best management (controls). GCS and haemodynamic variables were assessed during the hospital stay, and all patients were followed up at 3 months by an independent investigator, who was unaware of their treatment. Outcome, measured on the Glasgow outcome scale, at 3 months was good in 66\% of those treated with CGRP and 60\% in the controls; the relative risk of a poor outcome in CGRP-treated patients was 0.88 (95\% confidence interval 0.60 to 1.28). Hypotension was a common side-effect of the CGRP infusion. 66\% of the CGRP group did not complete treatment because of adverse events (19 patients), lack of improvement at 4 h (17 patients) or later (4 patients), or patient's request (1 patient).Although we could not show a significant beneficial effect of CGRP in this trial, the wide confidence interval for the risk of a poor outcome and the fact that only a third of patients completed treatment mean that a clinically useful benefit cannot yet be ruled out.",

keywords = "NERVE-FIBERS, HEMORRHAGE, VOLUNTEERS, CGRP",

author = "IC BAILEY and JA LYTTLE and B MATTHEW and G BRAADVEDT and RJ NELSON and G STRANJALIS and JP CASTEL and JM ORGOGOZO and AM AZIZ and TF BUCKLEY and RG GALVIN and A KESHTGAR and JC MARKS and J HUTCHISON and SA OLAOIRE and J SINGH and JD MILLER and GD MURRAY and I. BONE and GM TEASDALE and D GROSSET and P FOY and PRD HUMPHREY and K MORRIS and MDM SHAW and BA BELL and FG JOHNSTON and STAPLETON, \{S. R.\} and WAS TAYLOR and J.R. BARTLETT and D DORRANCE and RW GULLAN and IJA ROBERTSON and L CALANDRE and RD LOBATO and M BARNES and U CHOKSEY and JA COZENS and J MCMAHON and AD MENDELOW and DT HOPE and D JEFFERSON and B WHITE and Y KEREVAL and D MOHAN and PS DIAS and S HOWELL and J JAKUBOWSKI and B MARTIN and J MARTIN and JD PICKARD and J STANLEY and J LAGARRIGUE and V LARRUE and OP DAHL and R JUUL",

year = "1992",

month = apr,

day = "4",

language = "English",

volume = "339",

pages = "831--834",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier",

number = "8797",

}

BAILEY, IC, LYTTLE, JA, MATTHEW, B, BRAADVEDT, G, NELSON, RJ, STRANJALIS, G, CASTEL, JP, ORGOGOZO, JM, AZIZ, AM, BUCKLEY, TF, GALVIN, RG, KESHTGAR, A, MARKS, JC, HUTCHISON, J, OLAOIRE, SA, SINGH, J, MILLER, JD, MURRAY, GD, BONE, I, TEASDALE, GM, GROSSET, D, FOY, P, HUMPHREY, PRD, MORRIS, K, SHAW, MDM, BELL, BA, JOHNSTON, FG, STAPLETON, SR, TAYLOR, WAS, BARTLETT, JR, DORRANCE, D, GULLAN, RW, ROBERTSON, IJA, CALANDRE, L, LOBATO, RD, BARNES, M, CHOKSEY, U, COZENS, JA, MCMAHON, J, MENDELOW, AD, HOPE, DT, JEFFERSON, D, WHITE, B, KEREVAL, Y, MOHAN, D, DIAS, PS, HOWELL, S, JAKUBOWSKI, J, MARTIN, B, MARTIN, J, PICKARD, JD, STANLEY, J, LAGARRIGUE, J, LARRUE, V, DAHL, OP & JUUL, R 1992, 'EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE', The Lancet, vol. 339, no. 8797, pp. 831-834.

TY - JOUR

T1 - EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

AU - BAILEY, IC

AU - LYTTLE, JA

AU - MATTHEW, B

AU - BRAADVEDT, G

AU - NELSON, RJ

AU - STRANJALIS, G

AU - CASTEL, JP

AU - ORGOGOZO, JM

AU - AZIZ, AM

AU - BUCKLEY, TF

AU - GALVIN, RG

AU - KESHTGAR, A

AU - MARKS, JC

AU - HUTCHISON, J

AU - OLAOIRE, SA

AU - SINGH, J

AU - MILLER, JD

AU - MURRAY, GD

AU - BONE, I.

AU - TEASDALE, GM

AU - GROSSET, D

AU - FOY, P

AU - HUMPHREY, PRD

AU - MORRIS, K

AU - SHAW, MDM

AU - BELL, BA

AU - JOHNSTON, FG

AU - STAPLETON, S. R.

AU - TAYLOR, WAS

AU - BARTLETT, J.R.

AU - DORRANCE, D

AU - GULLAN, RW

AU - ROBERTSON, IJA

AU - CALANDRE, L

AU - LOBATO, RD

AU - BARNES, M

AU - CHOKSEY, U

AU - COZENS, JA

AU - MCMAHON, J

AU - MENDELOW, AD

AU - HOPE, DT

AU - JEFFERSON, D

AU - WHITE, B

AU - KEREVAL, Y

AU - MOHAN, D

AU - DIAS, PS

AU - HOWELL, S

AU - JAKUBOWSKI, J

AU - MARTIN, B

AU - MARTIN, J

AU - PICKARD, JD

AU - STANLEY, J

AU - LAGARRIGUE, J

AU - LARRUE, V

AU - DAHL, OP

AU - JUUL, R

PY - 1992/4/4

Y1 - 1992/4/4

N2 - The finding that the carotid vascular beds are sensitive to the potent vasodilator calcitonin-gene-related peptide (CGRP) suggested that the drug might help to prevent ischaemic deterioration after surgery for aneurysmal subarachnoid haemorrhage (SAH). The results of a preliminary study were encouraging, so we have carried out a randomised multicentre single-blind comparison of CGRP and standard best management in patients with ischaemic deficits after surgery for ruptured intracranial aneurysms.Patients aged 18-70 years in whom a focal neurological deficit developed or who had a reduction of 2 or more points on the Glasgow coma scale (GCS) after surgery entered the study after computed tomography had excluded non-ischaemic causes for the neurological deficit. 62 patients were randomly assigned an infusion of 0.6-mu-g/min CGRP for 4 h, then up to a maximum of 10 days, and 55 patients standard best management (controls). GCS and haemodynamic variables were assessed during the hospital stay, and all patients were followed up at 3 months by an independent investigator, who was unaware of their treatment. Outcome, measured on the Glasgow outcome scale, at 3 months was good in 66% of those treated with CGRP and 60% in the controls; the relative risk of a poor outcome in CGRP-treated patients was 0.88 (95% confidence interval 0.60 to 1.28). Hypotension was a common side-effect of the CGRP infusion. 66% of the CGRP group did not complete treatment because of adverse events (19 patients), lack of improvement at 4 h (17 patients) or later (4 patients), or patient's request (1 patient).Although we could not show a significant beneficial effect of CGRP in this trial, the wide confidence interval for the risk of a poor outcome and the fact that only a third of patients completed treatment mean that a clinically useful benefit cannot yet be ruled out.

AB - The finding that the carotid vascular beds are sensitive to the potent vasodilator calcitonin-gene-related peptide (CGRP) suggested that the drug might help to prevent ischaemic deterioration after surgery for aneurysmal subarachnoid haemorrhage (SAH). The results of a preliminary study were encouraging, so we have carried out a randomised multicentre single-blind comparison of CGRP and standard best management in patients with ischaemic deficits after surgery for ruptured intracranial aneurysms.Patients aged 18-70 years in whom a focal neurological deficit developed or who had a reduction of 2 or more points on the Glasgow coma scale (GCS) after surgery entered the study after computed tomography had excluded non-ischaemic causes for the neurological deficit. 62 patients were randomly assigned an infusion of 0.6-mu-g/min CGRP for 4 h, then up to a maximum of 10 days, and 55 patients standard best management (controls). GCS and haemodynamic variables were assessed during the hospital stay, and all patients were followed up at 3 months by an independent investigator, who was unaware of their treatment. Outcome, measured on the Glasgow outcome scale, at 3 months was good in 66% of those treated with CGRP and 60% in the controls; the relative risk of a poor outcome in CGRP-treated patients was 0.88 (95% confidence interval 0.60 to 1.28). Hypotension was a common side-effect of the CGRP infusion. 66% of the CGRP group did not complete treatment because of adverse events (19 patients), lack of improvement at 4 h (17 patients) or later (4 patients), or patient's request (1 patient).Although we could not show a significant beneficial effect of CGRP in this trial, the wide confidence interval for the risk of a poor outcome and the fact that only a third of patients completed treatment mean that a clinically useful benefit cannot yet be ruled out.

KW - NERVE-FIBERS

KW - HEMORRHAGE

KW - VOLUNTEERS

KW - CGRP

M3 - Article

SN - 0140-6736

VL - 339

SP - 831

EP - 834

JO - The Lancet

JF - The Lancet

IS - 8797

ER -

EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Abstract

Keywords / Materials (for Non-textual outputs)

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