Cerebral vasospasm: a review of current developments in drug therapy and research

Archavlis, Eleftherios; Nievas, Mario Carvi y

doi:10.7243/2050-120x-2-18

Cited by 9 publications

(9 citation statements)

References 142 publications

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“…The breakdown of the 40 articles was as follows: epidemiology (3), pathophysiology (9), time course (5), predictors (5), digital subtraction angiography (DSA; 4), CTA (3), CT perfusion (3), 3 electroencephalography (3), TCD ultrasonography (3), brain tissue oxygenation (1), microdialysis (2), thermal diffusion flowmetry (2), jugular bulb oximetry (2), and treatment (7) studies. The main findings are compiled in Table 1.…”

Section: Search Resultsmentioning

confidence: 99%

“…This decreases calcium influx into cells, which then decreases smooth muscle cell contractility, ultimately preventing vasospasm from occurring. 2 Although some moderately sized studies have shown that nimodipine has some benefit in reducing the incidence of vasospasm, large-scale meta-analyses have shown that differences in mortality rates were not statistically significant with the addition of nimodipine. 11 Stein and Le Roux proposed that there might be a role for nimodipine usage in a smaller subset of PTV cases as evidenced by a decreased incidence of vasospasm; however, this requires further investigation.…”

Section: Contemporary Paradigms In Management and Treatmentmentioning

confidence: 99%

“…Currently, less is known about the usage of papaverine than that of nimodipine; further study is required. 2 Lastly, endothelin receptor blockers at high doses, such as clazosentan at 15 mg/hr, displayed a reduction in vasospasm-related morbidity and all-cause mortality in the context of aSAH but did not show improved long-term functional outcomes. 17 This could be due to other confounding factors, such as side effects or study design, causing apparent persistent ischemia.…”

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confidence: 99%

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Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Al‐Mufti

Amuluru²,

Changa³

et al. 2017

Neurosurgical Focus

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OBJECTIVELittle is known regarding the natural history of posttraumatic vasospasm. The authors review the pathophysiology of posttraumatic vasospasm (PTV), its associated risk factors, the efficacy of the technologies used to detect PTV, and the management/treatment options available today.METHODSThe authors performed a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following databases: PubMed, Google Scholar, and CENTRAL (the Cochrane Central Register of Controlled Trials). Outcome variables extracted from each study included epidemiology, pathophysiology, time course, predictors of PTV and delayed cerebral ischemia (DCI), optimal means of surveillance and evaluation of PTV, application of multimodality monitoring, modern management and treatment options, and patient outcomes after PTV. Study types were limited to retrospective chart reviews, database reviews, and prospective studies.RESULTSA total of 40 articles were included in the systematic review. In many cases of mild or moderate traumatic brain injury (TBI), imaging or ultrasonographic studies are not performed. The lack of widespread assessment makes finding the true overall incidence of PTV a difficult endeavor. The clinical consequences of PTV are important, given the morbidity that can result from it. DCI manifests as new-onset neurological deterioration that occurs beyond the timeframe of initial brain injury. While there are many techniques that attempt to diagnose cerebral vasospasm, digital subtraction angiography is the gold standard. Some predictors of PTV include SAH, intraventricular hemorrhage, low admission Glasgow Coma Scale (GCS) score (< 9), and young age (< 30 years).CONCLUSIONSGiven these results, clinicians should suspect PTV in young patients presenting with intracranial hemorrhage (ICH), especially SAH and/or intraventricular hemorrhage, who present with a GCS score less than 9. Monitoring and regulation of CNS metabolism following TBI/ICH-induced vasospasm may play an important adjunct role to the primary prevention of vasospasm.

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Section: Search Resultsmentioning

confidence: 99%

Section: Contemporary Paradigms In Management and Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

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Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Al‐Mufti

Amuluru²,

Changa³

et al. 2017

Neurosurgical Focus

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“…Several medical therapies and the effect of lumbar drainage are being investigated. 2,30 Hydrocephalus Requiring a Shunt Several earlier publications have shown that chronic post-aSAH hydrocephalus is related to significant morbidity and readmission to the hospital. 1,5,12,18,29,40 Potential reasons for an impaired outcome after the need for permanent cerebrospinal fluid diversion have been discussed in a recent publication and included elevated intracranial pressure, injury from catheter misplacement, rehemorrhage, and shunt infections.…”

Section: Delayed Cerebral Vasospasm and Ischemiamentioning

confidence: 99%

Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients

Huhtakangas¹,

Lehečka²,

Lehto³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEOcclusive treatment of posterior communicating artery (PCoA) aneurysms has been seen as a fairly uncomplicated procedure. The objective here was to determine the radiological and clinical outcome of patients after PCoA aneurysm rupture and treatment and to evaluate the risk factors for impaired outcome.METHODSIn a retrospective clinical follow-up study, data were collected from 620 consecutive patients who had been treated for ruptured PCoA aneurysms at a single center between 1980 and 2014. The follow-up was a minimum of 1 year after treatment or until death.RESULTSOf the 620 patients, 83% were treated with microsurgical clipping, 8% with endovascular coiling, 2% with the two procedures combined, 1% with indirect surgical methods, and 6% with conservative methods. The most common procedural complications were treatment-related brain infarctions (15%). The occurrence of artery occlusions (10% microsurgical, 8% endovascular) was higher than expected. Most patients made a good recovery at 1 year after aneurysmal subarachnoid hemorrhage (modified Rankin Scale [mRS] score 0–2: 386 patients [62%]). A fairly small proportion of patients were left severely disabled (mRS score 4–5: 27 patients [4%]). Among all patients, 20% died during the 1st year. Independent risk factors for an unfavorable outcome, according to the multivariable analysis, were poor preoperative clinical condition, intracerebral or subdural hematoma due to aneurysm rupture, age over 65 years, artery occlusion on postoperative angiography, occlusive treatment–related ischemia, delayed cerebral vasospasm, and hydrocephalus requiring a shunt.CONCLUSIONSEven though most patients made a good recovery after PCoA aneurysm rupture and treatment during the 1st year, the occlusive treatment–related complications were higher than expected and caused morbidity even among initially good-grade patients. Occlusive treatment of ruptured PCoA aneurysms seems to be a high-risk procedure, even in a high-volume neurovascular center.

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“…The consequences of rupture of an aneurysm are both on the cerebral and systemic physiology leading to multi system changes (Chen et al, 2014). Despite technological advances in the management for prevention of rebleeding, the blood present in the intracranial space itself acts as a trigger for various inflammatory pathways leading to delayed cerebral ischemia and worsening the outcome of the patients or further adding to ongoing neurological insults (Archavlis andCarvi Y Nievas et al, 2013, Chaichana et al, 2010). Though the clinical spectrum of the disease has been established, mechanisms and pathophysiology of disease initiation and progression, i.e.…”

Section: Introductionmentioning

confidence: 99%

Proteome-wide characterization and biomarker identification of intracranial aneurysm

Sharma

Datta

Kumar

et al. 2019

Preprint

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The scientific basis of intracranial aneurysm (IA) formation, its rupture and further development of cerebral vasospasm remains incompletely understood. Deciphering the molecular mechanisms underlying these events will lead to identification of early detection biomarkers and in turn, improved treatment outcomes. Aberrant protein expression may drive structural alterations of vasculature found in IA. To unravel these aberrations, we performed untargeted, global, quantitative proteomic analysis of aneurysm tissue and serum from patients with IA. Samples were derived from patients of three clinical sub groups-1) unruptured aneurysm 2) ruptured aneurysm without vasospasm 3) ruptured aneurysm who developed vasospasm. A total of 937 and 294 proteins were identified in aneurysm tissue and serum samples respectively. Several proteins that are known to maintain the structural integrity of vasculature were found to be dysregulated. ORM1, a glycoprotein, was significantly upregulated in both the aneurysm tissue and serum samples of unruptured IA patients. We employed a larger cohort of patients and validated ORM1 as a potential biomarker for screening of unruptured aneurysm using ELISA. Samples from ruptured aneurysm with vasospasm showed significant upregulation of MMP9 as compared to ruptured aneurysm without vasospasm. Using a cohort of ruptured aneurysm patients with and without vasospasm, we validated MMP9 as a potential biomarker for vasospasm. This study reveals pathophysiology underlying different clinical sub groups of IA and also suggests potential biomarkers.

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Cerebral vasospasm: a review of current developments in drug therapy and research

Cited by 9 publications

References 142 publications

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients

Proteome-wide characterization and biomarker identification of intracranial aneurysm

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