Does Prevention of Vasospasm in Subarachnoid Hemorrhage Improve Clinical Outcome? Yes

Macdonald, R. Loch

doi:10.1161/strokeaha.112.679142

Cited by 18 publications

(11 citation statements)

References 25 publications

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“…Critics of this approach to treating angiographic vasospasm may cite uncertainty regarding the role of aVSP in delayed cerebral ischemia 21 22 23. A number of clinical trials of pharmaceutical agents have demonstrated improvement in the rate of moderate–severe vasospasm but not in the rate of favorable outcome 24 25.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, the therapeutic window is narrow11 12 (this probably accounts for a limited number of patients showing neurological improvement with vasodilator therapy or TBA22 23 39–43) and secondly, patients may suffer infarction in the absence of acute deterioration (especially if poor grade and difficult to assess) which itself is associated with a poor eventual outcome 16. A process of screening for and treating severe aVSP may allow more timely intervention prior to more severe ischemia but the risks of this approach need to be justified, and critical to this is the safety of the screening method and chemical and balloon angioplasty.…”

Section: Discussionmentioning

confidence: 99%

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The detrimental clinical impact of severe angiographic vasospasm may be diminished by maximal medical therapy and intensive endovascular treatment

Mortimer

Steinfort

Faulder

et al. 2014

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The detrimental clinical impact of severe angiographic vasospasm may be diminished by maximal medical therapy and intensive endovascular treatment

Mortimer

Steinfort

Faulder

et al. 2014

J NeuroIntervent Surg

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“…42 Over the past decade, several observations have weakened that association and opened up many new areas of investigation. 43,44 Histologically, following SAH there are structural alterations in endothelial and smooth muscle cells of the arterial wall. 45 The release of oxyhemoglobin into the subarachnoid space seems to instigate these changes.…”

Section: Vasospasm and Delayed Cerebral Ischemiamentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: Strategies for Preventing Vasospasm in the Intensive Care Unit

Diringer

Zazulia

2017

Semin Respir Crit Care Med

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This article addresses the intensive care unit (ICU) management of patients with aneurysmal subarachnoid hemorrhage (SAH), with an emphasis on the prevention of cerebral vasospasm and delayed cerebral ischemia (DCI), which are major contributors to morbidity and mortality. Interventions addressing various steps in the development of vasospasm have been attempted, with variable success. Enteral nimodipine remains the only approved measure to potentially prevent DCI. Since oral and intravenous administrations are limited by hypotension, direct administration via sustained-release pellets and intraventricular administration of sustained-release microparticles are being investigated. Studies of other calcium channel blockers have been disappointing. Efforts to remove blood from the subarachnoid space via cisternal irrigation, cisternal or ventricular thrombolysis, and lumbar cerebrospinal fluid drainage have met with limited and variable success, and they remain an area of active investigation. Several interventions that had early promise have failed to show benefit when studied in large trials; these include tirilazad, magnesium, statins, clazosentan, transluminal angioplasty, and hypervolemia.

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“…Whether prevention of vasospasm influences outcome is debatable [37,38] . One hypothesis is that the neurological outcome from SAH is dependent on the resulting direct brain injury, which is independent of and unaltered by vasospasm rescue.…”

Section: Corticosteroids' Influence On Sah Outcomesmentioning

confidence: 99%

Corticosteroids in the Management of Hyponatremia, Hypovolemia, and Vasospasm in Subarachnoid Hemorrhage: A Meta-Analysis

Mistry

Mistry²,

Kumar³

et al. 2016

Cerebrovasc Dis

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Background: Cerebral vasospasm and sodium and fluid imbalances are common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and cause of significant morbidity and mortality. Studies have shown the benefit of corticosteroids in the management of these sequelae. We have reviewed the literature and analyzed the available data for corticosteroid use after SAH. Methods: PubMed, EMBASE, and Cochrane electronic databases were searched without language restrictions, and 7 observational, controlled clinical studies of the effect of corticosteroids in the management of SAH patients were identified. Data on sodium and fluid balances, symptomatic vasospasm (SVS), and outcomes were pooled for meta-analyses using the Mantel-Haenszel random effects model. Results: Corticosteroids, specifically hydrocortisone and fludrocortisone, decreased natriuretic diuresis and incidence of hypovolemia. Corticosteroid administration is associated with lower incidence of SVS in the absence of nimodipine, but does not alter the neurological outcome. Conclusions: Supplementation of corticosteroids with mineralocorticoid activity, such as hydrocortisone or fludrocortisone, helps in maintaining sodium and volume homeostasis in SAH patients. Larger trials are warranted to confirm the effects of corticosteroids on SVS and patient outcomes.

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Does Prevention of Vasospasm in Subarachnoid Hemorrhage Improve Clinical Outcome? Yes

Cited by 18 publications

References 25 publications

The detrimental clinical impact of severe angiographic vasospasm may be diminished by maximal medical therapy and intensive endovascular treatment

The detrimental clinical impact of severe angiographic vasospasm may be diminished by maximal medical therapy and intensive endovascular treatment

Aneurysmal Subarachnoid Hemorrhage: Strategies for Preventing Vasospasm in the Intensive Care Unit

Corticosteroids in the Management of Hyponatremia, Hypovolemia, and Vasospasm in Subarachnoid Hemorrhage: A Meta-Analysis

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