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Neurocritical Care Aug 2023Delayed cerebral ischemia (DCI) is still a significant cause of death and disability after aneurysmal subarachnoid hemorrhage. Cerebral vasospasm represents one of the... (Review)
Review
Delayed cerebral ischemia (DCI) is still a significant cause of death and disability after aneurysmal subarachnoid hemorrhage. Cerebral vasospasm represents one of the most reported mechanisms associated with DCI. The management of DCI-related vasospasm remains a significant challenge for clinicians; induced hypertension, intraarterial vasodilators, and/or intracranial vessel angioplasty-particularly in refractory or recurrent cases-are the most used therapies. Because an essential role in the pathophysiology of cerebral vasospasm has been attributed to the adrenergic sympathetic nerves, a "sympatholytic" intervention, consisting of a temporary interruption of the sympathetic pathways using local anesthetics, has been advocated to minimize the vascular narrowing and reverse the consequences of cerebral vasospasm on tissue perfusion. In this review, we have analyzed the existing literature on the block of the cervical ganglions, particularly the stellate ganglion, in managing refractory cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. These findings could help clinicians to understand the potential role of such intervention and to develop future interventional trials in this setting.
Topics: Humans; Subarachnoid Hemorrhage; Vasospasm, Intracranial; Brain Ischemia; Cerebral Infarction; Sympathectomy
PubMed: 36828982
DOI: 10.1007/s12028-023-01694-5 -
Frontiers in Neuroscience 2023Intracranial aneurysms (IA) are the most common cerebral vascular pathologies. Their rupture leads to the most dangerous subtype of stroke-aneurysmal subarachnoid... (Review)
Review
Intracranial aneurysms (IA) are the most common cerebral vascular pathologies. Their rupture leads to the most dangerous subtype of stroke-aneurysmal subarachnoid hemorrhage (aSAH), which may be followed by cerebral vasospasm and ischemic sequelae. Recently, an imbalance within the intestinal microbiota, referred to as dysbiosis, was suggested to play a role in the formation, progression, and rupture of IA. As no systematic review on this topic exists, considering the significance of this matter and a lack of effective prophylaxis against IA or cerebral vasospasm, we aim to sum up the current knowledge regarding their associations with intestinal microbiome, identify the gaps, and determine future prospects. Scientific databases were systematically and independently searched by two authors from inception to 1st May 2023 for original articles regarding the role of intestinal microbiota in intracranial aneurysmal growth, aSAH occurrence, as well as in cerebral vasospasm following aSAH. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was followed in an abstraction process. The STROBE tool was applied to assess the risk of bias. This research was funded by the National Science Centre, Poland (grant number 2021/41/N/NZ2/00844). Of 302 records, four studies were included that fully met eligibility criteria. Studies reported (1) that the relative abundance of is a protective factor against aneurysm growth and rupture, resulting from the reduced inflammation and extracellular matrix remodeling in the cerebral arterial wall and from reduced metalloproteinase-mediated degradation of smooth muscle cells in cerebral vessels. (2) Relative abundance of is associated with aSAH. (3) No article has evaluated microbiota in relation to cerebral vasospasm following aSAH although there is an ongoing study. We concluded that intestinal microbiota might be a potential target for diagnostic and therapeutic tools to improve the management of cerebral aneurysms. However, more studies of prospective design are needed.
PubMed: 37928732
DOI: 10.3389/fnins.2023.1247151 -
Journal of Neurointerventional Surgery Jun 2024Vasospasm and delayed cerebral ischemia (DCI) are the leading causes of morbidity and mortality after intracranial aneurysmal subarachnoid hemorrhage (aSAH). Vasospasm...
BACKGROUND
Vasospasm and delayed cerebral ischemia (DCI) are the leading causes of morbidity and mortality after intracranial aneurysmal subarachnoid hemorrhage (aSAH). Vasospasm detection, prevention and management, especially endovascular management varies from center to center and lacks standardization. We aimed to evaluate this variability via an international survey of how neurointerventionalists approach vasospasm diagnosis and endovascular management.
METHODS
We designed an anonymous online survey with 100 questions to evaluate practice patterns between December 2021 and September 2022. We contacted endovascular neurosurgeons, neuroradiologists and neurologists via email and via two professional societies - the Society of NeuroInterventional Surgery (SNIS) and the European Society of Minimally Invasive Neurological Therapy (ESMINT). We recorded the physicians' responses to the survey questions.
RESULTS
A total of 201 physicians (25% [50/201] USA and 75% non-USA) completed the survey over 10 months, 42% had >7 years of experience, 92% were male, median age was 40 (IQR 35-46). Both high-volume and low-volume centers were represented. Daily transcranial Doppler was the most common screening method (75%) for vasospasm. In cases of symptomatic vasospasm despite optimal medical management, endovascular treatment was directly considered by 58% of physicians. The most common reason to initiate endovascular treatment was clinical deficits associated with proven vasospasm/DCI in 89%. The choice of endovascular treatment and its efficacy was highly variable. Nimodipine was the most common first-line intra-arterial therapy (40%). Mechanical angioplasty was considered the most effective endovascular treatment by 65% of neurointerventionalists.
CONCLUSION
Our study highlights the considerable heterogeneity among the neurointerventional community regarding vasospasm diagnosis and endovascular management. Randomized trials and guidelines are needed to improve standard of care, determine optimal management approaches and track outcomes.
Topics: Humans; Vasospasm, Intracranial; Subarachnoid Hemorrhage; Endovascular Procedures; Male; Female; Practice Patterns, Physicians'; Middle Aged; Adult; Surveys and Questionnaires; Neurosurgeons
PubMed: 37500477
DOI: 10.1136/jnis-2023-020544 -
JACC. Cardiovascular Interventions May 2024
Topics: Humans; Predictive Value of Tests; Coronary Artery Disease; Prognosis; Coronary Angiography
PubMed: 38749589
DOI: 10.1016/j.jcin.2024.04.003 -
Journal of Cardiology Oct 2023
Topics: Humans; Coronary Vasospasm; Muscle Spasticity; Angina Pectoris; Myocardial Ischemia
PubMed: 37597878
DOI: 10.1016/j.jjcc.2023.06.009 -
Neurocritical Care Jan 2024
PubMed: 38267802
DOI: 10.1007/s12028-023-01922-y -
Medicine Aug 2023The purpose of this study is to compare the prognosis and effective rate of interventional embolization and surgical clipping in the treatment of middle cerebral artery... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The purpose of this study is to compare the prognosis and effective rate of interventional embolization and surgical clipping in the treatment of middle cerebral artery aneurysms, to provide evidence-based basis for the selection of clinical treatment.
METHODS
By searching PubMed, Cochrane library, Medline, Embase and other databases, we collected the related studies interventional embolization and surgical clipping in the treatment of middle cerebral artery aneurysms, whether it was a randomized controlled trial or not. According to the relevant inclusion and exclusion criteria, 2 researchers independently screened and extracted the relevant data. Quality of life, residual neck and recurrence rate, incidence of ischemic cerebral infarction, intracranial infection rate, incidence of vasospasm and rebleeding rate were measured. Revman5.4 software was used for Meta-analysis.
RESULTS
There were 3658 patients included in 30 literatures, including 1478 patients treated with interventional embolization and 2180 patients treated with surgical clipping. The rate of low quality of life (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.36-2.07, P < .00001) and intracranial infection rate (OR = 8.79,95% CI: 4.47-17.27, P < .00001) in the interventional embolization group were lower than those in the surgical clipping group. The postoperative rebleeding rate (OR = 0.46, 95% CI: 0.29-0.73, P = .0009), residual neck and recurrence rate (OR = 0.32, 95% CI: 0.24-0.43, P < .00001) in the interventional embolization group were higher than those in the surgical clipping group. The heterogeneity of residual neck and recurrence rate were high, so subgroup analysis was performed. We divide them into short-term group (OR = 0.68, 95% CI: 0.40-1.13, P = .13) and long-term group (OR = 0.23, 95% CI: 0.16-0.33, P < .00001). The results showed that the residual neck and recurrence rate in the interventional embolization group were higher than those in the surgical clipping group. There was no significant difference in the incidence of cerebral vasospasm (OR = 1.09, 95% CI: 0.64-1.86, P = .74) and ischemic stroke (OR = 0.87, 95% CI: 0.63-1.19, P = .37) between the 2 treatments.
CONCLUSION
According to the current clinical research evidence, compared with interventional embolization in the treatment of middle cerebral artery aneurysms, the quality of life of patients after clipping is lower, the incidence of intracranial infection is higher, but the residual neck, and recurrence rate are reduced. The risk of rebleeding is also reduced. There was no significant difference in the incidence of vasospasm and ischemic stroke between the 2 groups.
Topics: Humans; Intracranial Aneurysm; Quality of Life; Embolization, Therapeutic; Databases, Factual; Ischemic Stroke; Randomized Controlled Trials as Topic
PubMed: 37653731
DOI: 10.1097/MD.0000000000034956 -
Journal of Neurointerventional Surgery Oct 2023Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) contributes significant morbidity and mortality after brain aneurysm rupture. However, the association...
BACKGROUND
Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) contributes significant morbidity and mortality after brain aneurysm rupture. However, the association between vascular territory of vasospasm and clinical outcome has not been studied. We present a hypothesis-generating study to determine whether the location of vasospasm within the intracranial circulation is associated with functional outcome after SAH.
METHODS
A retrospective analysis of a prospective, intention-to-treat trial for aneurysmal SAH was performed to supplement trial outcomes with in-hospital angiographic imaging and treatment variables regarding vasospasm. The location of vasospasm and the position on the vessel (distal vs proximal) were evaluated. Modified Rankin scale (mRS) outcomes were assessed at discharge and 6 months, and predictive models were constructed.
RESULTS
A total of 406 patients were included, 341 with follow-up data at 6 months. At discharge, left-sided vasospasm was associated with poor outcome (odds ratio (OR), 2.37; 95% CI, 1.25 to 4.66; P=0.01). At 6 months, anterior cerebral artery (ACA) vasospasm (OR, 3.87; 95% CI, 1.29 to 11.88; P=0.02) and basilar artery (BA) vasospasm (OR, 6.22; 95% CI, 1.54 to 27.11; P=0.01) were associated with poor outcome after adjustment. A model predicting 6-month mRS score and incorporating vasospasm variables achieved an area under the curve of 0.85 and a net improvement in reclassification of 13.2% (P<0.01) compared with a previously validated predictive model for aneurysmal SAH.
CONCLUSIONS
In aneurysmal SAH, left-sided vasospasm is associated with worse discharge functional status. At 6 months, both ACA and BA vasospasm are associated with unfavorable functional status.
Topics: Humans; Subarachnoid Hemorrhage; Retrospective Studies; Vasospasm, Intracranial; Prospective Studies; Intracranial Aneurysm
PubMed: 36379702
DOI: 10.1136/jnis-2022-019016 -
Reviews in the Neurosciences Jun 2024Cerebral vasospasm and delayed cerebral ischemia represent a very challenging aspect of cerebrovascular pathophysiology, most commonly subarachnoid hemorrhage, with... (Review)
Review
Cerebral vasospasm and delayed cerebral ischemia represent a very challenging aspect of cerebrovascular pathophysiology, most commonly subarachnoid hemorrhage, with significantly high mortality if left untreated. Considerable advances have been made in medical treatment and prompt diagnosis, while newer endovascular modalities have recently been proposed for cases of resistant cerebral vasospasm. However, there is still paucity of data regarding which and whether a single endovascular technique is non inferior to the pharmacological standard of care. In this review, we aim to summarize the current funds of knowledge concerning cerebral vasospasm and the emerging role of the endovascular techniques for its treatment.
Topics: Humans; Endovascular Procedures; Brain Ischemia; Vasospasm, Intracranial
PubMed: 38278624
DOI: 10.1515/revneuro-2023-0148 -
European Annals of Allergy and Clinical... Nov 2023Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. To establish the prevalence of KS among the...
Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. To establish the prevalence of KS among the patients with diagnosis of anaphylaxis, we described clinical features, cardiological and allergological outcomes of patients evaluated in our allergy outpatient clinic. A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents. We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to Hymenoptera stings, 5/9 to drugs). The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.
Topics: Adult; Animals; Humans; Anaphylaxis; Kounis Syndrome; Hymenoptera; Retrospective Studies; Insect Bites and Stings
PubMed: 35850501
DOI: 10.23822/EurAnnACI.1764-1489.260