REmifentanil And Dexmedetomidine for EarlY Intensive Blood Pressure Lowering in ICH.

Summary

Intracerebral hemorrhage (ICH) remains the most devastating subtype of stroke, with a case fatality rate of approximately 40% at one months post-onset, imposing a particularly heavy medical and economic burden on low- and middle-income countries. Studies have shown that poor prognosis in ICH patients is associated with acute blood pressure elevation and hematoma expansion after onset. Blood pressure control during the acute phase is considered a potentially key therapeutic strategy for improving outcomes in ICH patients; however, no clinical study has yet demonstrated a clear advantage of any specific antihypertensive agent or combination. Previous researchers have confirmed that the combined use of remifentanil and dexmedetomidine, while providing effective analgesia, sedation, and anti-sympathetic effects, could reduce dramatic fluctuations in blood pressure and heart rate, thereby facilitating more stable blood pressure reduction and potentially further improving functional outcomes in ICH patients. The investigators plan to conduct a multicenter, prospective, randomized controlled, superiority clinical trial within mainland China to evaluate the efficacy and safety of an early intensive blood pressure-lowering strategy using remifentanil combined with dexmedetomidine for improving functional prognosis in acute ICH patients. This study aims to provide evidence-based medical support for the use of remifentanil combined with dexmedetomidine in early intensive blood pressure-lowering in patients with ICH, to enrich the available options for early intensive blood pressure-lowering strategies, to improve the adverse prognosis of patients.

Timeline

Start

2026-07-31

Primary completion

2028-10-01

Completion

2028-12-31

Publications

• Background Cro S, Morris TP, Kenward MG, Carpenter JR. Sensitivity analysis for clinical trials with missing continuous outcome data using controlled multiple imputation: A practical guide. Stat Med. 2020 Sep 20;39(21):2815-2842. doi: 10.1002/sim.8569. Epub 2020 May 17.
• Background Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014 Aug;13(8):844-54. doi: 10.1016/S1474-4422(14)70120-6.
• Background Society Of Critical Care Medicine Chinese Medical Association. [Guidelines for analgesia and sedation treatment in intensive care unit of Chinese adults]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jun;30(6):497-514. doi: 10.3760/cma.j.issn.2095-4352.2018.06.001. No abstract available. Chinese.
• Background Hopewell S, Chan AW, Collins GS, Hrobjartsson A, Moher D, Schulz KF, Tunn R, Aggarwal R, Berkwits M, Berlin JA, Bhandari N, Butcher NJ, Campbell MK, Chidebe RCW, Elbourne D, Farmer A, Fergusson DA, Golub RM, Goodman SN, Hoffmann TC, Ioannidis JPA, Kahan BC, Knowles RL, Lamb SE, Lewis S, Loder E, Offringa M, Ravaud P, Richards DP, Rockhold FW, Schriger DL, Siegfried NL, Staniszewska S, Taylor RS, Thabane L, Torgerson D, Vohra S, White IR, Boutron I. CONSORT 2025 statement: updated guideline for reporting randomised trials. BMJ. 2025 Apr 14;389:e081123. doi: 10.1136/bmj-2024-081123.
• Background Liu GG, Wu H, Li M, Gao C, Luo N. Chinese time trade-off values for EQ-5D health states. Value Health. 2014 Jul;17(5):597-604. doi: 10.1016/j.jval.2014.05.007. Epub 2014 Jul 23.
• Background Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001 Jul;33(5):337-43. doi: 10.3109/07853890109002087.
• Background Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989 Jul;20(7):864-70. doi: 10.1161/01.str.20.7.864.
• Background Saver JL. Optimal end points for acute stroke therapy trials: best ways to measure treatment effects of drugs and devices. Stroke. 2011 Aug;42(8):2356-62. doi: 10.1161/STROKEAHA.111.619122. Epub 2011 Jun 30.
• Background Xiong J, Quan J, Qin C, Wang X, Dong Q, Zhang B. Remifentanil pretreatment attenuates brain nerve injury in response to cardiopulmonary bypass by blocking AKT/NRF2 signal pathway. Immunopharmacol Immunotoxicol. 2022 Aug;44(4):574-585. doi: 10.1080/08923973.2022.2069577. Epub 2022 Apr 29.
• Background Unchiti K, Leurcharusmee P, Samerchua A, Pipanmekaporn T, Chattipakorn N, Chattipakorn SC. The potential role of dexmedetomidine on neuroprotection and its possible mechanisms: Evidence from in vitro and in vivo studies. Eur J Neurosci. 2021 Nov;54(9):7006-7047. doi: 10.1111/ejn.15474. Epub 2021 Oct 25.
• Background Song HL, Zhang SB. Therapeutic effect of dexmedetomidine on intracerebral hemorrhage via regulating NLRP3. Eur Rev Med Pharmacol Sci. 2019 Mar;23(6):2612-2619. doi: 10.26355/eurrev_201903_17411.
• Background Huang J, Jiang Q. Dexmedetomidine Protects Against Neurological Dysfunction in a Mouse Intracerebral Hemorrhage Model by Inhibiting Mitochondrial Dysfunction-Derived Oxidative Stress. J Stroke Cerebrovasc Dis. 2019 May;28(5):1281-1289. doi: 10.1016/j.jstrokecerebrovasdis.2019.01.016. Epub 2019 Feb 20.
• Background Liu H, Busl KM, Dore S. Role of Dexmedetomidine in Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Scoping Review. J Neurosurg Anesthesiol. 2022 Apr 1;34(2):176-182. doi: 10.1097/ANA.0000000000000728.
• Background Tipps LB, Coplin WM, Murry KR, Rhoney DH. Safety and feasibility of continuous infusion of remifentanil in the neurosurgical intensive care unit. Neurosurgery. 2000 Mar;46(3):596-601; discussion 601-2. doi: 10.1097/00006123-200003000-00015.
• Background Bischoff P, Plumer L, Scholz J, Drogemeier K, von Knobelsdorff G, Schulte am Esch J. [Effect of remifentanil on clinical and electroencephalographic parameters of depth of anesthesia in balanced anesthesia with propofol, enflurane or isoflurane]. Anaesthesiol Reanim. 1998;23(5):116-23. German.
• Background Ren C, Gao J, Xu GJ, Xu H, Liu G, Liu L, Zhang L, Cao JL, Zhang Z. The Nimodipine-Sparing Effect of Perioperative Dexmedetomidine Infusion During Aneurysmal Subarachnoid Hemorrhage: A Prospective, Randomized, Controlled Trial. Front Pharmacol. 2019 Aug 2;10:858. doi: 10.3389/fphar.2019.00858. eCollection 2019.
• Background Tang CL, Li J, Zhang ZT, Zhao B, Wang SD, Zhang HM, Shi S, Zhang Y, Xia ZY. Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization. Neural Regen Res. 2018 Feb;13(2):280-288. doi: 10.4103/1673-5374.226399.
• Background Potocnik I, Andjelkovic-Juvan L, Hostnik A, Markovic-Bozic J. Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial. Croat Med J. 2021 Jun 30;62(3):233-240. doi: 10.3325/cmj.2021.62.233.
• Background Zeng XL, Liao JH, Zhong HS, Yin XH, Wang R, Liang JP, Zhang ZS. Meta-Analysis on the Anesthetic Effects of Remifentanil plus Dexmedetomidine versus Remifentanil Alone in Cardiac Surgery. Comput Math Methods Med. 2022 Sep 28;2022:1077980. doi: 10.1155/2022/1077980. eCollection 2022.
• Background Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin. 2009 Jul;25(3):451-69, vii. doi: 10.1016/j.ccc.2009.04.004.
• Background Yi S, Cao H, Zheng W, Wang Y, Li P, Wang S, Zhou Z. Targeting the opioid remifentanil: Protective effects and molecular mechanisms against organ ischemia-reperfusion injury. Biomed Pharmacother. 2023 Nov;167:115472. doi: 10.1016/j.biopha.2023.115472. Epub 2023 Sep 15.
• Background Stroumpos C, Manolaraki M, Paspatis GA. Remifentanil, a different opioid: potential clinical applications and safety aspects. Expert Opin Drug Saf. 2010 Mar;9(2):355-64. doi: 10.1517/14740331003672579.
• Background Fodale V, Schifilliti D, Pratico C, Santamaria LB. Remifentanil and the brain. Acta Anaesthesiol Scand. 2008 Mar;52(3):319-26. doi: 10.1111/j.1399-6576.2007.01566.x.
• Background Pereon Y, Aubertin P, Guiheneuc P. Prognostic significance of electrophysiological investigations in stroke patients: somatosensory and motor evoked potentials and sympathetic skin response. Neurophysiol Clin. 1995;25(3):146-57. doi: 10.1016/0987-7053(96)80167-5.
• Background Sykora M, Diedler J, Turcani P, Hacke W, Steiner T. Baroreflex: a new therapeutic target in human stroke? Stroke. 2009 Dec;40(12):e678-82. doi: 10.1161/STROKEAHA.109.565838. Epub 2009 Oct 15.
• Background Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008 Jul 8;118(2):176-87. doi: 10.1161/CIRCULATIONAHA.107.723874. No abstract available.
• Background Gupta H, Beshara S, Katsanos A, Patil T, Al-Zahrani S, Chen JY, Alharbi A, Zamir N, Ng K, Kase CS, Shoamanesh A. Acute Hyperglycemia and In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage. Can J Neurol Sci. 2023 Jan;50(1):115-118. doi: 10.1017/cjn.2021.497. Epub 2021 Dec 6.
• Background Chen S, Wan Y, Guo H, Shen J, Li M, Xia Y, Zhang L, Sun Z, Chen X, Li G, He Q, Hu B. Diabetic and stress-induced hyperglycemia in spontaneous intracerebral hemorrhage: A multicenter prospective cohort (CHEERY) study. CNS Neurosci Ther. 2023 Apr;29(4):979-987. doi: 10.1111/cns.14033. Epub 2022 Nov 29.
• Background Wang X, Sandset EC, Moullaali TJ, Chen G, Song L, Carcel C, Delcourt C, Woodward M, Robinson T, Chalmers J, Arima H, Anderson CS; INTERACT2 Investigators. Determinants of the high admission blood pressure in mild-to-moderate acute intracerebral hemorrhage. J Hypertens. 2019 Jul;37(7):1463-1466. doi: 10.1097/HJH.0000000000002056.
• Background Hamann GF, Strittmatter M, Hoffmann KH, Holzer G, Stoll M, Keshevar T, Moili R, Wein K, Schimrigk K. Pattern of elevation of urine catecholamines in intracerebral haemorrhage. Acta Neurochir (Wien). 1995;132(1-3):42-7. doi: 10.1007/BF01404846.
• Background Leow MK, Loh KC, Kiat Kwek T, Ng PY. Catecholamine and metanephrine excess in intracerebral haemorrhage: revisiting an obscure yet common "pseudophaeochromocytoma". J Clin Pathol. 2007 May;60(5):583-4. doi: 10.1136/jcp.2006.036640. No abstract available.
• Background Takahashi H. Aldosterone, catecholamines, and CK-BB as biochemical markers in hypertensive intracerebral hemorrhage. Neurol Med Chir (Tokyo). 1989 Nov;29(11):999-1003. doi: 10.2176/nmc.29.999.
• Background Liang XM, Chen J, Zhang T, Liu J, Jiang XJ, Xu ZQ. Cerebral hemorrhage increases plasma concentrations of noradrenalin and creatine kinase MB fraction with induction of cardiomyocyte damage in rats. Cell Biochem Biophys. 2014 Dec;70(3):1807-11. doi: 10.1007/s12013-014-0133-z.
• Background Ma L, Hu X, Song L, Chen X, Ouyang M, Billot L, Li Q, Malavera A, Li X, Munoz-Venturelli P, de Silva A, Thang NH, Wahab KW, Pandian JD, Wasay M, Pontes-Neto OM, Abanto C, Arauz A, Shi H, Tang G, Zhu S, She X, Liu L, Sakamoto Y, You S, Han Q, Crutzen B, Cheung E, Li Y, Wang X, Chen C, Liu F, Zhao Y, Li H, Liu Y, Jiang Y, Chen L, Wu B, Liu M, Xu J, You C, Anderson CS; INTERACT3 Investigators. The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial. Lancet. 2023 Jul 1;402(10395):27-40. doi: 10.1016/S0140-6736(23)00806-1. Epub 2023 May 25.
• Background Shoamanesh A, Patrice Lindsay M, Castellucci LA, Cayley A, Crowther M, de Wit K, English SW, Hoosein S, Huynh T, Kelly M, O'Kelly CJ, Teitelbaum J, Yip S, Dowlatshahi D, Smith EE, Foley N, Pikula A, Mountain A, Gubitz G, Gioia LC. Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020. Int J Stroke. 2021 Apr;16(3):321-341. doi: 10.1177/1747493020968424. Epub 2020 Nov 11.
• Background Mutimer CA, Yassi N, Wu TY. Blood Pressure Management in Intracerebral Haemorrhage: when, how much, and for how long? Curr Neurol Neurosci Rep. 2024 Jul;24(7):181-189. doi: 10.1007/s11910-024-01341-2. Epub 2024 May 23.
• Background Sandset EC, Anderson CS, Bath PM, Christensen H, Fischer U, Gasecki D, Lal A, Manning LS, Sacco S, Steiner T, Tsivgoulis G. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. Eur Stroke J. 2021 Jun;6(2):II. doi: 10.1177/23969873211026998. Epub 2021 Jun 18.
• Background Cao Y, Yu S, Zhang Q, Yu T, Liu Y, Sun Z, Zhao M, Wang W, Zhao JZ; Chinese Stroke Association Stroke Council Guideline. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of intracerebral haemorrhage. Stroke Vasc Neurol. 2020 Dec;5(4):396-402. doi: 10.1136/svn-2020-000433. Epub 2020 Dec 1.
• Background Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016 Sep 15;375(11):1033-43. doi: 10.1056/NEJMoa1603460. Epub 2016 Jun 8.
• Background Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, Hata J, Arima H, Parsons M, Li Y, Wang J, Heritier S, Li Q, Woodward M, Simes RJ, Davis SM, Chalmers J; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013 Jun 20;368(25):2355-65. doi: 10.1056/NEJMoa1214609. Epub 2013 May 29.
• Background Parry-Jones AR, Jarhult SJ, Kreitzer N, Morotti A, Toni D, Seiffge D, Mendelow AD, Patel H, Brouwers HB, Klijn CJ, Steiner T, Gibler WB, Goldstein JN. Acute care bundles should be used for patients with intracerebral haemorrhage: An expert consensus statement. Eur Stroke J. 2024 Jun;9(2):295-302. doi: 10.1177/23969873231220235. Epub 2023 Dec 27.
• Background Corrections. Lancet Neurol. 2018 Nov;17(11):933. doi: 10.1016/S1474-4422(18)30354-5. Epub 2018 Sep 19. No abstract available.
• Background Brouwers HB, Chang Y, Falcone GJ, Cai X, Ayres AM, Battey TW, Vashkevich A, McNamara KA, Valant V, Schwab K, Orzell SC, Bresette LM, Feske SK, Rost NS, Romero JM, Viswanathan A, Chou SH, Greenberg SM, Rosand J, Goldstein JN. Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol. 2014 Feb;71(2):158-64. doi: 10.1001/jamaneurol.2013.5433.
• Background Dong R, Li F, Li B, Chen Q, Huang X, Zhang J, Huang Q, Zhang Z, Cao Y, Yang M, Li J, Li Z, Li C, Liu G, Zhong S, Feng G, Zhang M, Xiao Y, Lin K, Shen Y, Shao H, Shi Y, Yu X, Li X, Yao L, Du X, Xu Y, Kang P, Gao G, Ouyang B, Chen W, Zeng Z, Chen P, Chen C, Yang H. Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial. Anesthesiology. 2024 Jul 1;141(1):100-115. doi: 10.1097/ALN.0000000000004986.
• Background Li Q, Yakhkind A, Alexandrov AW, Alexandrov AV, Anderson CS, Dowlatshahi D, Frontera JA, Hemphill JC, Ganti L, Kellner C, May C, Morotti A, Parry-Jones A, Sheth KN, Steiner T, Ziai W, Goldstein JN, Mayer SA. Code ICH: A Call to Action. Stroke. 2024 Feb;55(2):494-505. doi: 10.1161/STROKEAHA.123.043033. Epub 2023 Dec 15.
• Background Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 2004 Jun;35(6):1364-7. doi: 10.1161/01.STR.0000128795.38283.4b. Epub 2004 Apr 29.
• Background Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Manios E, Konstantopoulou P, Mavrikakis M. U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med. 2004 Feb;255(2):257-65. doi: 10.1046/j.1365-2796.2003.01291.x.
• Background Okumura K, Ohya Y, Maehara A, Wakugami K, Iseki K, Takishita S. Effects of blood pressure levels on case fatality after acute stroke. J Hypertens. 2005 Jun;23(6):1217-23. doi: 10.1097/01.hjh.0000170385.76826.4a.
• Background Zhang Y, Reilly KH, Tong W, Xu T, Chen J, Bazzano LA, Qiao D, Ju Z, Chen CS, He J. Blood pressure and clinical outcome among patients with acute stroke in Inner Mongolia, China. J Hypertens. 2008 Jul;26(7):1446-52. doi: 10.1097/HJH.0b013e328300a24a.
• Background Leasure AC, Qureshi AI, Murthy SB, Kamel H, Goldstein JN, Woo D, Ziai WC, Hanley DF, Al-Shahi Salman R, Matouk CC, Sansing LH, Sheth KN, Falcone GJ. Association of Intensive Blood Pressure Reduction With Risk of Hematoma Expansion in Patients With Deep Intracerebral Hemorrhage. JAMA Neurol. 2019 Aug 1;76(8):949-955. doi: 10.1001/jamaneurol.2019.1141.
• Background Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC 3rd, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS; American Heart Association/American Stroke Association. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2022 Jul;53(7):e282-e361. doi: 10.1161/STR.0000000000000407. Epub 2022 May 17. No abstract available.
• Background Bako AT, Pan A, Potter T, Tannous J, Johnson C, Baig E, Meeks J, Woo D, Vahidy FS. Contemporary Trends in the Nationwide Incidence of Primary Intracerebral Hemorrhage. Stroke. 2022 Mar;53(3):e70-e74. doi: 10.1161/STROKEAHA.121.037332. Epub 2022 Feb 3.
• Background van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010 Feb;9(2):167-76. doi: 10.1016/S1474-4422(09)70340-0. Epub 2010 Jan 5.
• Background Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009 Apr;8(4):355-69. doi: 10.1016/S1474-4422(09)70025-0. Epub 2009 Feb 21.
• Background An SJ, Kim TJ, Yoon BW. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. J Stroke. 2017 Jan;19(1):3-10. doi: 10.5853/jos.2016.00864. Epub 2017 Jan 31.
• Background Poon MT, Fonville AF, Al-Shahi Salman R. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014 Jun;85(6):660-7. doi: 10.1136/jnnp-2013-306476. Epub 2013 Nov 21.
• Background Parry-Jones AR, Krishnamurthi R, Ziai WC, Shoamanesh A, Wu S, Martins SO, Anderson CS. World Stroke Organization (WSO): Global intracerebral hemorrhage factsheet 2025. Int J Stroke. 2025 Feb;20(2):145-150. doi: 10.1177/17474930241307876. Epub 2025 Jan 6.
• Background GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795-820. doi: 10.1016/S1474-4422(21)00252-0. Epub 2021 Sep 3.
• Background Steiner T, Purrucker JC, Aguiar de Sousa D, Apostolaki-Hansson T, Beck J, Christensen H, Cordonnier C, Downer MB, Eilertsen H, Gartly R, Gerner ST, Ho L, Holt Jahr S, Klijn CJ, Martinez-Majander N, Orav K, Petersson J, Raabe A, Sandset EC, Schreuder FH, Seiffge D, Al-Shahi Salman R. European Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS) guideline on stroke due to spontaneous intracerebral haemorrhage. Eur Stroke J. 2025 Dec;10(4):1007-1086. doi: 10.1177/23969873251340815. Epub 2025 May 22.
• Background Qureshi AI, Qureshi MH. Acute hypertensive response in patients with intracerebral hemorrhage pathophysiology and treatment. J Cereb Blood Flow Metab. 2018 Sep;38(9):1551-1563. doi: 10.1177/0271678X17725431. Epub 2017 Aug 16.
• Background Sheth KN. Spontaneous Intracerebral Hemorrhage. N Engl J Med. 2022 Oct 27;387(17):1589-1596. doi: 10.1056/NEJMra2201449. No abstract available.

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