Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review.
Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review.
复制标题
DOI：
10.1161/jaha.121.021845
复制
发表时间：
2021-08-03
影响因子：
5.4
通讯作者：
Chalouhi N
中科院分区：
文献类型：
--
作者：
Dodd WS;Laurent D;Dumont AS;Hasan DM;Jabbour PM;Starke RM;Hosaka K;Polifka AJ;Hoh BL;Chalouhi N
迟发性脑缺血是蛛网膜下腔出血患者预后不良的主要预测因素。尽管进行了多年的研究和临床试验，但治疗方案有限，而且往往无效。基础科学的现代进步已经产生了一个更加复杂的多因素框架，在这个框架中，迟发性脑缺血得到了更好的理解，并且可以开发出新的治疗方法。然而，利用这些知识来改善结果取决于对疾病过程的全面理解。我们对文献进行了回顾，以分析迟发性脑缺血的研究现状，重点是过去几十年来出现的主要主题。具体来说，我们讨论微循环功能障碍，胶质淋巴损伤，炎症，神经电干扰的病理因素，除了典型的重点脑血管痉挛。本文旨在为临床医生和研究人员提供迟发性脑缺血病理生理学基础的总结，同时也强调病理因素之间的相互作用和相互依赖性。通过这一概述，我们还强调了转化研究的进展和未来潜在的治疗机会。
Delayed cerebral ischemia is a major predictor of poor outcomes in patients who suffer subarachnoid hemorrhage. Treatment options are limited and often ineffective despite many years of investigation and clinical trials. Modern advances in basic science have produced a much more complex, multifactorial framework in which delayed cerebral ischemia is better understood and novel treatments can be developed. Leveraging this knowledge to improve outcomes, however, depends on a holistic understanding of the disease process. We conducted a review of the literature to analyze the current state of investigation into delayed cerebral ischemia with emphasis on the major themes that have emerged over the past decades. Specifically, we discuss microcirculatory dysfunction, glymphatic impairment, inflammation, and neuroelectric disruption as pathological factors in addition to the canonical focus on cerebral vasospasm. This review intends to give clinicians and researchers a summary of the foundations of delayed cerebral ischemia pathophysiology while also underscoring the interactions and interdependencies between pathological factors. Through this overview, we also highlight the advances in translational studies and potential future therapeutic opportunities.