The role of arterioles and the microcirculation in the development of vasospasm after aneurysmal SAH.
The role of arterioles and the microcirculation in the development of vasospasm after aneurysmal SAH.
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DOI：
10.1155/2014/253746
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发表时间：
2014
影响因子：
--
通讯作者：
Ohkuma H
中科院分区：
文献类型：
--
作者：
Naraoka M;Matsuda N;Shimamura N;Asano K;Ohkuma H
脑大动脉的脑血管痉挛，其特征是血管造影显示血管狭窄，已被认为是蛛网膜下腔出血（SAH）患者迟发性脑缺血（DCI）的主要原因。然而，consciousness -1试验显示，尽管克唑生坦成功地降低了血管痉挛的相对风险，但它不能改善死亡率或临床结果。这一结果表明，DCI背后的病理生理是多因素的，其他独立于血管造影血管痉挛的病理生理因素也可能导致这种结果。最近的研究集中在微循环障碍，如微血栓形成和小动脉收缩，作为影响SAH后脑缺血的因素。本文将回顾检测微血栓形成和小动脉收缩的报道，并讨论微循环在SAH后血管痉挛期间脑缺血中的作用。
Cerebral vasospasm of the major cerebral arteries, which is characterized by angiographic narrowing of those vessels, had been recognized as a main contributor to delayed cerebral ischemia (DCI) in subarachnoid hemorrhage (SAH) patients. However, the CONSCIOUS-1 trial revealed that clazosentan could not improve mortality or clinical outcome in spite of successful reduction of relative risk in angiographic vasospasm. This result indicates that the pathophysiology underlying DCI is multifactorial and that other pathophysiological factors, which are independent of angiographic vasospasm, can contribute to the outcome. Recent studies have focused on microcirculatory disturbance, such as microthrombosis and arteriolar constriction, as a factor affecting cerebral ischemia after SAH. Reports detecting microthrombosis and arteriolar constriction will be reviewed, and the role of the microcirculation on cerebral ischemia during vasospasm after SAH will be discussed.