Potential role of aspirin in the prevention of aneurysmal subarachnoid hemorrhage.
Potential role of aspirin in the prevention of aneurysmal subarachnoid hemorrhage.
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DOI：
10.1159/000381137
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Hasan DM
中科院分区：
文献类型：
--
作者：
Starke RM;Chalouhi N;Ding D;Hasan DM
Inflammation is a key element behind the pathophysiology of cerebral aneurysm formation and rupture. Aspirin is a potent inhibitor of cyclooxygenase-2 (COX) which plays a critical role in the expression of immune modulators known to contribute to cerebral aneurysm formation and rupture. Currently, there are no pharmacological therapies for patients with cerebral aneurysms. Both endovascular and microsurgical interventions may be associated with significant morbidity and mortality. Potentially, a medical alternative that prevents aneurysm progression and rupture may be a beneficial therapy for a significant number of patients. In animal models treatment with aspirin and genetic inactivation of COX-2 decreases aneurysm formation and rupture. Selective inhibition of COX-1 did not decrease aneurysm rupture suggesting that selection inhibition of COX-2 may be critical for aneurysm progression. Walls of ruptured human intracranial aneurysms have higher levels of COX-2 and microsomal prostaglandin E2 synthase 1 (mPGES-1), both of which are known to be inhibited by aspirin. In a pilot study, patients treated with aspirin prior to microsurgical clipping had attenuated expression of COX-2, mPGES-1, and macrophages in aneurysm walls after 3 months of aspirin therapy. Additionally, in patients undergoing endovascular therapy, local circulating expression of chemokines and COX-2 were increased in blood samples taken from within aneurysm domes as compared to peripheral blood sample controls. Treatment with aspirin also resulted in decreased expression of expression of COX-2 within leukocytes within aneurysms as compared to peripheral blood samples. Novel molecular imaging with ferumoxytol-enhanced MRI may allow for identification of patients at increased risk for aneurysm rupture and assessment of a response to aspirin therapy. Aspirin has been found to be a safe in patients harboring cerebral aneurysms and clinical studies provide evidence that it may decrease the overall rate of rupture. Furthermore, aspirin is an accessible and inexpensive for patients that may not have access to endovascular or microsurgical treatment or for patients deemed low risk of aneurysm rupture, high risk for intervention, or both. Future clinical trials are indicated to determine the overall effect of aspirin on aneurysm progression and rupture. This review provides an update on the potential mechanisms and benefits of aspirin in the treatment of cerebral aneurysms.
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影响因子：
4.6
作者：
Chalouhi N;Ali MS;Starke RM;Jabbour PM;Tjoumakaris SI;Gonzalez LF;Rosenwasser RH;Koch WJ;Dumont AS
通讯作者：
Dumont AS
影响因子：
8.3
作者：
Hasan DM;Mahaney KB;Brown RD Jr;Meissner I;Piepgras DG;Huston J;Capuano AW;Torner JC;International Study of Unruptured Intracranial Aneurysms Investigators
通讯作者：
International Study of Unruptured Intracranial Aneurysms Investigators
影响因子：
8.3
作者：
Hasan D;Hashimoto T;Kung D;Macdonald RL;Winn HR;Heistad D
通讯作者：
Heistad D
影响因子：
37.8
作者：
Grines, Cindy L.;Bonow, Robert O.;Whitlow, Patrick
通讯作者：
Whitlow, Patrick
影响因子：
158.5
作者：
Chimowitz, MI;Lynn, MJ;Romano, JG
通讯作者：
Romano, JG