Association Between Spreading Depolarization and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: Post Hoc Analysis of a Randomized Trial of the Effect of Cilostazol on Delayed Cerebral Ischemia
Association Between Spreading Depolarization and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: Post Hoc Analysis of a Randomized Trial of the Effect of Cilostazol on Delayed Cerebral Ischemia
复制标题
DOI：
10.1007/s12028-021-01330-0
复制
发表时间：
2021-08-30
影响因子：
3.5
通讯作者：
Suzuki, Michiyasu
中科院分区：
文献类型：
--
作者：
Kawano, Akiko;Sugimoto, Kazutaka;Suzuki, Michiyasu
背景动脉瘤性蛛网膜下腔出血(SAH)后迟发性脑缺血(DCI)仍然是一个具有复杂病理生理机制的重要问题。我们利用一项单中心随机试验的数据，评估了磷酸二酯酶抑制剂西洛他唑对动脉瘤性蛛网膜下腔出血患者的疗效，以探讨DCI与血管痉挛、扩散性除极(SD)和微循环障碍的关系。方法采用单中心前瞻性随机试验，研究西洛他唑对动脉瘤性蛛网膜下腔出血后DCI和SD的影响。在所有随机队列中，纳入了发病后第9+/-2天同时接受SD监测和数字减影血管造影术(DSA)的患者。脑循环时间(CCT)由DSA获得，分为近端CCT和外周CCT(作为微循环障碍的衡量标准)。采用Logistic回归分析确定与DCI相关的因素。结果50例患者中有28例获得完整数据。在28名患者中，8名(28.5%)在研究期间发生了DCI。多因素分析显示，行数字减影血管造影术当天(即发病后延迟的时间点)的抑郁发生率与扩张性脑缺血密切相关(优势比2.064，95%可信区间1.045~4.075，P=0.037，曲线下面积0.836)，而血管造影血管痉挛程度和外周CCT对扩张性脑梗死的影响不显著。结论SD与DCI有很强的相关性。我们的结果表明SD是DCI的一个重要的治疗靶点和一个潜在的有用的生物标志物。
Background Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) remains an important problem with a complex pathophysiology. We used data from a single-center randomized trial to assess the effect of a phosphodiesterase inhibitor, cilostazol, in patients with aneurysmal SAH to explore the relationships of DCI with vasospasm, spreading depolarization (SD) and microcirculatory disturbance. Methods A post hoc analysis of a single-center, prospective, randomized trial of the effect of cilostazol on DCI and SD after aneurysmal SAH was performed. From all randomized cohorts, patients who underwent both SD monitoring and digital subtraction angiography (DSA) on day 9 +/- 2 from onset were included. Cerebral circulation time (CCT), which was divided into proximal CCT and peripheral CCT (as a measure of microcirculatory disturbance), was obtained from DSA. Logistic regression was conducted to determine factors associated with DCI. Results Complete data were available for 28 of 50 patients. Of the 28 patients, 8 (28.5%) had DCI during the study period. Multivariate analysis indicated a strong association between the number of SDs on the day DSA was performed (i.e., a delayed time point after SAH onset) and DCI (odds ratio 2.064, 95% confidence interval 1.045-4.075, P = 0.037, area under the curve 0.836), whereas the degree of angiographic vasospasm and peripheral CCT were not significant factors for DCI. Conclusions There is a strong association between SD and DCI. Our results suggest that SD is an important therapeutic target and a potentially useful biomarker for DCI.