scholarly journals Effectiveness of high dose eicosapentaenoic acid for prevention of cerebral vasospasm secondary to subarachnoid hemorrhage

Nosotchu ◽  
2010 ◽  
Vol 32 (2) ◽  
pp. 146-150
Author(s):  
Hirokazu Nakatogawa ◽  
Tomohiro Yamasaki ◽  
Nakao Ota ◽  
Tadashi Doden ◽  
Tomohiro Yamazoe ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Eicosapentaenoic Acid ◽  
Cerebral Vasospasm ◽  
High Dose

scholarly journals A Phase I proof-of-concept and safety trial of sildenafil to treat cerebral vasospasm following subarachnoid hemorrhage

2016 ◽  
Vol 124 (2) ◽  
pp. 318-327 ◽  
Author(s):  
Chad W. Washington ◽  
Colin P. Derdeyn ◽  
Rajat Dhar ◽  
Eric J. Arias ◽  
Michael R. Chicoine ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Phase I ◽  
Cerebral Vasospasm ◽  
Dose Group ◽  
Adverse Reactions ◽  
High Dose ◽  
Second Phase ◽  
Percentage Increase ◽  
Proof Of Concept ◽  
Average Percentage

OBJECT Studies show that phosphodiesterase-V (PDE-V) inhibition reduces cerebral vasospasm (CVS) and improves outcomes after experimental subarachnoid hemorrhage (SAH). This study was performed to investigate the safety and effect of sildenafil (an FDA-approved PDE-V inhibitor) on angiographic CVS in SAH patients. METHODS A2-phase, prospective, nonrandomized, human trial was implemented. Subarachnoid hemorrhage patients underwent angiography on Day 7 to assess for CVS. Those with CVS were given 10 mg of intravenous sildenafil in the first phase of the study and 30 mg in the second phase. In both, angiography was repeated 30 minutes after infusion. Safety was assessed by monitoring neurological examination findings and vital signs and for the development of adverse reactions. For angiographic assessment, in a blinded fashion, pre- and post-sildenafil images were graded as “improvement” or “no improvement” in CVS. Unblinded measurements were made between pre- and post-sildenafil angiograms. RESULTS Twelve patients received sildenafil; 5 patients received 10 mg and 7 received 30 mg. There were no adverse reactions. There was no adverse effect on heart rate or intracranial pressure. Sildenafil resulted in a transient decline in mean arterial pressure, an average of 17% with a return to baseline in an average of 18 minutes. Eight patients (67%) were found to have a positive angiographic response to sildenafil, 3 (60%) in the low-dose group and 5 (71%) in the high-dose group. The largest degree of vessel dilation was an average of 0.8 mm (range 0–2.1 mm). This corresponded to an average percentage increase in vessel diameter of 62% (range 0%–200%). CONCLUSIONS The results from this Phase I safety and proof-of-concept trial assessing the use of intravenous sildenafil in patients with CVS show that sildenafil is safe and well tolerated in the setting of SAH. Furthermore, the angiographic data suggest that sildenafil has a positive impact on human CVS.

High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

2008 ◽  
Vol 108 (3) ◽  
pp. 458-463 ◽  
Author(s):  
Janine Keuskamp ◽  
Raj Murali ◽  
Kuo H. Chao
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Senior Author ◽  
High Dose ◽  
Channel Blockers ◽  
Hemodynamic Stability ◽  
Arterial Blood ◽  
Intracranial Pressures ◽  
Blood Pressures

Object Because oral calcium channel blockers appear to reduce the severity of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH), interest in their application intraarterially has emerged for cases in which noninvasive means of alleviating vasospasm are unsuccessful. Studies to date have been limited to the administration of low intraarterial doses because of concerns about hemodynamic stability and changes in intracranial pressure. These doses, although effective in cases of milder vasospasm, were inadequate in severe cases. The authors present a series of 10 patients with cerebral vasospasm who underwent 12 procedures in which they received ≥ 20 mg of intraarterial verapamil per procedure. Methods A retrospective review was undertaken of all patients who underwent endovascular treatment for cerebral vasospasm due to aneurysmal SAH by the senior author between February 2005 and October 2006. Ten patients were identified who had undergone a total of 12 procedures during which ≥20 mg of intraarterial verapamil had been administered. From angiography reports, anesthesia records, and nursing records, we obtained pre- and postverapamil mean arterial blood pressures (MABPs), heart rates, intracranial pressures (ICPs) (when available), and visible changes in the degree of vasospasm. Results No statistically significant changes in MABP, heart rate, or ICP were observed after administration of ≥ 20 mg of intraarterial verapamil, and the degree of improvement in vasospasm was statistically significant based on our grading system. No correlation was found between the change in hemodynamic parameters and the total dose of verapamil. Conclusions This study indicates that high-dose intraarterial verapamil may be used to treat cerebral vasospasm without compromising hemodynamic stability or increasing ICP.

scholarly journals Norepinephrine as a Potential Aggravator of Symptomatic Cerebral Vasospasm: Two Cases and Argument for Milrinone Therapy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
F. A. Zeiler ◽  
J. Silvaggio ◽  
A. M. Kaufmann ◽  
L. M. Gillman ◽  
M. West
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Cerebral Vasospasm ◽  
Neurological Examination ◽  
Potential Role ◽  
Delayed Cerebral Ischemia ◽  
High Dose ◽  
Symptomatic Vasospasm ◽  
Blood Pressures ◽  
Hypertensive Therapy

Background.During hypertensive therapy for post-subarachnoid hemorrhage (SAH) symptomatic vasospasm, norepinephrine is commonly used to reach target blood pressures. Concerns over aggravation of vasospasm with norepinephrine exist.Objective.To describe norepinephrine temporally related deterioration in neurological examination of two post-SAH patients in vasospasm.Methods.We retrospectively reviewed two charts of patients with delayed cerebral ischemia (DCI) post-SAH who deteriorated with norepinephrine infusions.Results.We identified two patients with DCI post-SAH who deteriorated during hypertensive therapy with norepinephrine. The first, a 43-year-old male presented to hospital with DCI, failed MABP directed therapy with rapid deterioration in exam with high dose norepinephrine and MABP of 140–150 mm Hg. His exam improved on continuous milrinone and discontinuation of norepinephrine. The second, a 39-year-old female who developed DCI on postbleed day 8 responded to milrinone therapy upfront. During further deterioration and after angioplasty, norepinephrine was utilized to drive MABP to 130–140 mm Hg. Progressive deterioration in examination occurred after angioplasty as norepinephrine doses escalated. After discontinuation of norepinephrine and continuation of milrinone, function dramatically returned but not to baseline.Conclusions.The potential exists for worsening of DCI post-SAH with hypertensive therapy directed by norepinephrine. A potential role exists for vasodilation and inotropic directed therapy with milrinone in the setting of DCI post-SAH.

High-dose Bosentan in the Prevention and Treatment of Subarachnoid Hemorrhage-induced Cerebral Vasospasm: An Open-label Feasibility Study

2007 ◽  
Vol 7 (3) ◽  
pp. 194-202 ◽  
Author(s):  
Raul G. Nogueira ◽  
Michael J. Bodock ◽  
Walter J. Koroshetz ◽  
Mehmet A. Topcuoglu ◽  
Bob S. Carter ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Feasibility Study ◽  
High Dose ◽  
Open Label ◽  
Prevention And Treatment
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