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Rasmussen R, Bache S, Stavngaard T, Møller K. Plasma Levels of IL-6, IL-8, IL-10, ICAM-1, VCAM-1, IFNγ, and TNFα are not Associated with Delayed Cerebral Ischemia, Cerebral Vasospasm, or Clinical Outcome in Patients with Subarachnoid Hemorrhage. World Neurosurg 2019; 128:e1131-e1136. [PMID: 31121365 DOI: 10.1016/j.wneu.2019.05.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Delayed cerebral ischemia (DCI) is a serious and frequent complication following subarachnoid hemorrhage (SAH). The pathophysiology behind DCI remains poorly understood, but inflammation has been proposed to play a significant role. This study investigated the relationship between plasma levels of some of the most important inflammatory markers and DCI, cerebral vasospasm, and functional outcome in patients with SAH. METHODS In 90 patients with SAH, interleukin-6, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, high sensitivity C-reactive protein (HsCRP), interleukin-8, interleukin-10, interferon gamma, and tumor necrosis factor alpha were measured in peripheral blood day 3 and day 8 after SAH. Any occurrence of DCI or infection was recorded, and computed tomography angiography was performed on day 8. Clinical outcome was assessed after 3 months. RESULTS HsCRP on day 3 was higher in patients with angiographic vasospasm (P = 0.003), and HsCRP on day 8 was higher in patients with poor outcome (P = 0.014). No association with DCI, vasospasm, or outcome was found for any of the remaining analyzed substances. CONCLUSIONS High plasma levels of HsCRP were significantly associated with angiographic vasospasm and clinical outcome. Plasma levels of interleukin-6, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, interleukin-8, interleukin-10, interferon gamma, and tumor necrosis factor alpha were not associated with DCI, angiographic vasospasm, or clinical outcome at 3 months.
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Affiliation(s)
- Rune Rasmussen
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Søren Bache
- Department of Neuroanesthesiology, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Trine Stavngaard
- Department of Radiology, The Diagnostic Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanesthesiology, The Neuroscience Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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Gybel-Brask M, Rasmussen R, Stensballe J, Johansson PI, Ostrowski SR. Effect of delayed onset prostacyclin on markers of endothelial function and damage after subarachnoid hemorrhage. Acta Neurochir (Wien) 2017; 159:1073-1078. [PMID: 28386837 DOI: 10.1007/s00701-017-3168-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is a neurological emergency. Delayed ischemic neurological deficit is one of the main causes of poor outcome after SAH and is probably caused, at least in part, by cerebral vasospasm. The pathophysiology of this is multifaceted, but endothelial damage and activation as well as glycocalyx damage have been implicated. Prostacyclin has been shown to protect damaged and activated endothelium and to facilitate glycocalyx repair. We investigated biomarkers of endothelial activation and damage in patients with SAH randomized to 5 days prostacyclin infusion or placebo. METHODS Patients with aneurysmal SAH managed by coiling or surgery, and a World Federation of Neurological Surgeons score between 1 and 4, and Fisher grade 3 or 4, were treated with a continuous low-dose intravenous prostacyclin infusion or placebo initiated on day 5 and discontinued on day 10 after SAH. Blood samples were drawn from the patients before, during and after prostacyclin/placebo infusion. Soluble biomarkers of endothelial cell activation (sE-selectin, sVE-cadherin) and damage (sTM), glycocalyx damage (syndecan-1) and sympathoadrenal activation (adrenaline, noradrenaline), were measured by ELISA. RESULTS Ninety patients were randomized. Prostacyclin infusion influenced neither biomarkers of sympathoadrenal activation, endothelial activation and damage nor biomarkers of endothelial glycocalyx breakdown. CONCLUSIONS We did not find any effects on markers of sympathoadrenal activation, endothelial damage and activation, or glycocalyx degradation of delayed onset prostacyclin infusion compared to placebo. Further trials investigating early onset endothelial repair using prostacyclin are warranted.
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Affiliation(s)
- Mikkel Gybel-Brask
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Rune Rasmussen
- Department of Neurosurgery, Neurocenter, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jakob Stensballe
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Surgery, University of Texas Health Medical School, Houston, TX, USA
- Center for Systems Biology, School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | - Sisse R Ostrowski
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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High Plasma Levels of Neuropeptide Y Correlate With Good Clinical Outcome But are not Correlated to Cerebral Blood Flow or Vasospasm After Subarachnoid Hemorrhage. J Neurosurg Anesthesiol 2016; 28:65-70. [DOI: 10.1097/ana.0000000000000191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rasmussen R, Wetterslev J, Stavngaard T, Juhler M, Skjøth-Rasmussen J, Grände PO, Olsen NV. Effects of Prostacyclin on Cerebral Blood Flow and Vasospasm After Subarachnoid Hemorrhage. Stroke 2015; 46:37-41. [DOI: 10.1161/strokeaha.114.007470] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rune Rasmussen
- From the Department of Neurosurgery, The Neuroscience Centre (R.R., M.J., J.S.-R.), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), Department of Radiology, The Diagnostic Centre (T.S.), and Department of Neuroanesthesia, The Neuroscience Centre (N.V.O.), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden (P.O.G.); and Department of
| | - Jørn Wetterslev
- From the Department of Neurosurgery, The Neuroscience Centre (R.R., M.J., J.S.-R.), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), Department of Radiology, The Diagnostic Centre (T.S.), and Department of Neuroanesthesia, The Neuroscience Centre (N.V.O.), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden (P.O.G.); and Department of
| | - Trine Stavngaard
- From the Department of Neurosurgery, The Neuroscience Centre (R.R., M.J., J.S.-R.), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), Department of Radiology, The Diagnostic Centre (T.S.), and Department of Neuroanesthesia, The Neuroscience Centre (N.V.O.), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden (P.O.G.); and Department of
| | - Marianne Juhler
- From the Department of Neurosurgery, The Neuroscience Centre (R.R., M.J., J.S.-R.), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), Department of Radiology, The Diagnostic Centre (T.S.), and Department of Neuroanesthesia, The Neuroscience Centre (N.V.O.), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden (P.O.G.); and Department of
| | - Jane Skjøth-Rasmussen
- From the Department of Neurosurgery, The Neuroscience Centre (R.R., M.J., J.S.-R.), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), Department of Radiology, The Diagnostic Centre (T.S.), and Department of Neuroanesthesia, The Neuroscience Centre (N.V.O.), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden (P.O.G.); and Department of
| | - Per Olof Grände
- From the Department of Neurosurgery, The Neuroscience Centre (R.R., M.J., J.S.-R.), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), Department of Radiology, The Diagnostic Centre (T.S.), and Department of Neuroanesthesia, The Neuroscience Centre (N.V.O.), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden (P.O.G.); and Department of
| | - Niels Vidiendal Olsen
- From the Department of Neurosurgery, The Neuroscience Centre (R.R., M.J., J.S.-R.), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), Department of Radiology, The Diagnostic Centre (T.S.), and Department of Neuroanesthesia, The Neuroscience Centre (N.V.O.), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden (P.O.G.); and Department of
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Rasmussen R, Juhler M, Wetterslev J. Effects of continuous prostacyclin infusion on regional blood flow and cerebral vasospasm following subarachnoid haemorrhage: statistical analysis plan for a randomized controlled trial. Trials 2014; 15:228. [PMID: 24929796 PMCID: PMC4067113 DOI: 10.1186/1745-6215-15-228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/03/2014] [Indexed: 11/19/2022] Open
Abstract
Background One of the main causes of mortality and morbidity following subarachnoid hemorrhage (SAH) is the development of cerebral vasospasm, a frequent complication arising in the weeks after the initial bleeding. Despite extensive research, no effective treatment of vasospasm exists to date. Prostacyclin is a potent vasodilator and inhibitor of platelet aggregation. In vitro models have shown a relaxing effect of prostacyclin after induced contraction in cerebral arteries, and a recent pilot trial showed a positive effect on cerebral vasospasm in a clinical setting. No randomized clinical trials have investigated the possible pharmacodynamic effects of prostacyclin on the human brain following SAH. Methods/Design This trial is a single centre, randomized, placebo-controlled, parallel group, double blinded, clinical pilot trial. A total of 90 patients with SAH will be randomized to one of three intervention arms: epoprostenol at 1 ng/kg/min, epoprostenol at 2 ng/kg/min, or placebo in addition to the standard treatment. Trial medication will start on Day 5 after SAH and continue to Day 10. The primary outcome measure is changes in cerebral blood flow measured by a computed tomography (CT) perfusion scan. The secondary outcomes are vasospasm measured by a CT angiography, regional blood flow, clinical symptoms of cerebral ischemia, and outcome at three months (Glasgow Outcome Scale). Discussion The primary outcome has been altered slightly since the publication of our study protocol. Global cerebral blood flow is now primary outcome, whereas regional blood flow is a secondary outcome. Trial registration Clinicaltrials.gov NCT01447095. Registration date: 11 October 2011.
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Affiliation(s)
- Rune Rasmussen
- Department of Neurosurgery, Copenhagen University Hospital, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
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Siasios I, Kapsalaki EZ, Fountas KN. Cerebral vasospasm pharmacological treatment: an update. Neurol Res Int 2013; 2013:571328. [PMID: 23431440 PMCID: PMC3572649 DOI: 10.1155/2013/571328] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/27/2012] [Indexed: 11/17/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage- (aSAH-) associated vasospasm constitutes a clinicopathological entity, in which reversible vasculopathy, impaired autoregulatory function, and hypovolemia take place, and lead to the reduction of cerebral perfusion and finally ischemia. Cerebral vasospasm begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. Several therapeutic modalities have been employed for preventing or reversing cerebral vasospasm. Triple "H" therapy, balloon and chemical angioplasty with superselective intra-arterial injection of vasodilators, administration of substances like magnesium sulfate, statins, fasudil hydrochloride, erythropoietin, endothelin-1 antagonists, nitric oxide progenitors, and sildenafil, are some of the therapeutic protocols, which are currently employed for managing patients with aSAH. Intense pathophysiological mechanism research has led to the identification of various mediators of cerebral vasospasm, such as endothelium-derived, vascular smooth muscle-derived, proinflammatory mediators, cytokines and adhesion molecules, stress-induced gene activation, and platelet-derived growth factors. Oral, intravenous, or intra-arterial administration of antagonists of these mediators has been suggested for treating patients suffering a-SAH vasospam. In our current study, we attempt to summate all the available pharmacological treatment modalities for managing vasospasm.
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Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Eftychia Z. Kapsalaki
- Department of Diagnostic Radiology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Kostas N. Fountas
- Department of Neurosurgery, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece
- Institute of Biomolecular & Biomedical Research (BIOMED), Center for Research and Technology - Thessaly (CERETETH), 38500 Larissa, Greece
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