論文

国際誌
2021年8月30日

Association Between Spreading Depolarization and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: Post Hoc Analysis of a Randomized Trial of the Effect of Cilostazol on Delayed Cerebral Ischemia.

Neurocritical care
  • Akiko Kawano
  • ,
  • Kazutaka Sugimoto
  • ,
  • Sadahiro Nomura
  • ,
  • Takao Inoue
  • ,
  • Reo Kawano
  • ,
  • Fumiaki Oka
  • ,
  • Hirokazu Sadahiro
  • ,
  • Hideyuki Ishihara
  • ,
  • Michiyasu Suzuki

35
Suppl 2
開始ページ
91
終了ページ
99
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1007/s12028-021-01330-0

BACKGROUND: Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) remains an important problem with a complex pathophysiology. We used data from a single-center randomized trial to assess the effect of a phosphodiesterase inhibitor, cilostazol, in patients with aneurysmal SAH to explore the relationships of DCI with vasospasm, spreading depolarization (SD) and microcirculatory disturbance. METHODS: A post hoc analysis of a single-center, prospective, randomized trial of the effect of cilostazol on DCI and SD after aneurysmal SAH was performed. From all randomized cohorts, patients who underwent both SD monitoring and digital subtraction angiography (DSA) on day 9 ± 2 from onset were included. Cerebral circulation time (CCT), which was divided into proximal CCT and peripheral CCT (as a measure of microcirculatory disturbance), was obtained from DSA. Logistic regression was conducted to determine factors associated with DCI. RESULTS: Complete data were available for 28 of 50 patients. Of the 28 patients, 8 (28.5%) had DCI during the study period. Multivariate analysis indicated a strong association between the number of SDs on the day DSA was performed (i.e., a delayed time point after SAH onset) and DCI (odds ratio 2.064, 95% confidence interval 1.045-4.075, P = 0.037, area under the curve 0.836), whereas the degree of angiographic vasospasm and peripheral CCT were not significant factors for DCI. CONCLUSIONS: There is a strong association between SD and DCI. Our results suggest that SD is an important therapeutic target and a potentially useful biomarker for DCI.

リンク情報
DOI
https://doi.org/10.1007/s12028-021-01330-0
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/34462881
ID情報
  • DOI : 10.1007/s12028-021-01330-0
  • PubMed ID : 34462881

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