The effect of timing of clot removal on chronic vasospasm in a primate model.
The effect of timing of clot removal on chronic vasospasm in a primate model.
复制标题
灵长类动物模型中血栓清除时间对慢性血管痉挛的影响。
作者：
Yuji Handa;B. Weir;M. Nosko;Russ Mosewich;T. Tsuji;M. Grace
评价蛛网膜下腔出血（SAH）后48 - 96小时完全清除凝块对慢性脑血管痉挛发展的影响，以确定是否存在一个临界点，在此点后凝块清除对预防血管痉挛无效。将30只食蟹猴随机分为5组：假手术组、SAH后48小时凝块清除组（48小时组）、SAH后72小时凝块清除组（72小时组）、SAH后96小时凝块清除组（96小时组）和仅放置凝块组（凝块组）。采用标准显微外科技术分离双侧无蛛网膜的主要脑动脉。在48小时、72小时、96小时和凝块组中，将平均4.2 gm的自体血凝块放置在猴蛛网膜下腔的血管周围。将生理盐水滴入假手术动物的蛛网膜下腔。凝块去除组中的动物在每组的确定时间进行手术凝块去除。在SAH后48、72和96小时，分别对假手术组和凝块组中的两只动物进行再次手术。重新打开切口，然后简单地重新闭合。在SAH诱导前和诱导后7天评估神经功能状态、血管造影脑血管口径和生理状态。在假手术、48小时或72小时组中没有显著的神经功能缺损。在SAH诱导后第4天或第5天，96小时组和凝块组各有两只动物显示意识水平恶化。第7天，凝块组和96小时组动物的所有主要脑动脉均显示出显著的血管痉挛（p <0.01）。72小时组动物的颈内动脉和大脑中动脉出现显著的血管痉挛（p <0.05），但大脑前动脉没有。在48小时组中，任何脑动脉均无显著血管痉挛（p> 0.05）。血管痉挛的严重程度取决于血凝块与脑血管接触的持续时间。蛛网膜下腔出血后48小时后清除蛛网膜下腔血肿并不能显著降低慢性脑血管痉挛的程度。这表明，凝块清除在早期手术可能是有用的，只有在48小时内进行SAH。
The effect of complete clot removal at times from 48 to 96 hours after subarachnoid hemorrhage (SAH) on the development of chronic cerebral vasospasm was evaluated to determine whether there is a critical point after which clot removal is ineffective in preventing vasospasm. Thirty cynomolgus monkeys were randomized to one of five groups: sham-operated group, clot removal at 48 hours after SAH (48-hour group), clot removal at 72 hours after SAH (72-hour group), clot removal at 96 hours after SAH (96-hour group), and clot placement only (clot group). Standard microsurgical techniques were used to dissect bilaterally the major cerebral arteries free of arachnoid. An autologous blood clot averaging 4.2 gm was placed around the vessels in the subarachnoid space of the monkeys in the 48-hour, 72-hour, 96-hour, and clot groups. Physiological saline was instilled into the subarachnoid space of the sham-operated animals. Animals in the clot-removal groups underwent surgical clot removal at the determined times for each group. Two animals in each of the sham-operated and clot groups were subjected to reoperation at each of 48, 72, and 96 hours after SAH. The incisions were reopened and then simply reclosed. Neurological status, angiographic cerebral vessel caliber, and physiological status were evaluated before and 7 days after SAH induction. There were no significant neurological deficits in the sham-operated, 48-hour, or 72-hour groups. Two animals in each of the 96-hour and clot groups showed deterioration in level of consciousness developing on Day 4 or 5 after SAH induction. All the major cerebral arteries of the animals in the clot and 96-hour groups showed significant vasospasm (p less than 0.01) on Day 7. Animals in the 72-hour group had significant vasospasm (p less than 0.05) of the internal carotid and middle cerebral arteries but not the anterior cerebral arteries. There was no significant vasospasm (p greater than 0.05) in any of the cerebral arteries in the 48-hour group. Severity of vasospasm paralleled the duration of contact between the blood clot and the cerebral vessels. Evacuation of the subarachnoid hematoma later than 48 hours after SAH resulted in no significant reduction in the degree of chronic cerebral vasospasm. It is suggested that clot removal at early operation is likely to be useful only if it is performed within 48 hours of SAH.
影响因子：
4.1
作者：
LISZCZAK, TM;VARSOS, VG;ZERVAS, NT
通讯作者：
ZERVAS, NT