Influence of spot sign on the association between rapidly achieving blood pressure reduction and intracerebral haemorrhage outcomes

INTRODUCTION: Patients with a CTA spot sign could benefit more from interventions to limit ICH expansion. We evaluated whether its presence modifies the association between systolic blood pressure (SBP) reduction and ICH outcomes. PATIENTS AND METHODS: A prospective study of patients with ICH < 6 hours and SBP ≥ 150 mmHg at 2 Comprehensive Stroke Centers in Barcelona over 4.5 years. Patients underwent multiphase CTA (arterial, peak venous and late venous phases) and received treatment targeting SBP ≤ 140 mmHg ≤ 60 minutes. We assessed independent associations and interaction of achieving SBP target ≤ 60 minutes and spot sign status (arterial, or secondarily any phase) with hematoma expansion (>6 mL or > 33%) at 24 hours (primary outcome) and 90-day mRS. RESULTS: Among 207 patients (mean age 71 ± 13.2 years, 134 [64.7%] male), 67 (32.4%) presented an arterial spot sign and 122 (58.9%) achieved SBP target ≤ 60 minutes. Target rates were similar with and without arterial spot sign (38 [56.7%] vs 84 [60.0%], P = .653). Hematoma expansion occurred in 46/177 (26.0%), and median 90-day mRS was 4 (2-5). Arterial spot sign and SBP target ≤ 60 minutes were independently associated with hematoma expansion (adjusted odds ratio [aOR] 4.07; 95% CI, 1.74-9.89 and aOR 0.27; 95% CI, 0.11-0.64) and 90-day mRS (aOR 2.23; 95% CI, 1.23-4.07 and aOR 0.43; 95% CI, 0.24-0.76), with no interaction between them (P = .575 and P = .187, respectively). Similar results were observed considering spot sign in any multiphase CTA phase. CONCLUSION: The association between rapidly achieving SBP reduction and ICH outcomes appears neither dependent on nor modified by spot sign status.