Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

Young Woo Kim, Gregory J. Zipfel, Christopher S. Ogilvy, Katie L. Pricola, Babu G. Welch, Nabeel Shakir, Bhuvic Patel, John F. Reavey-Cantwell, Craig R. Kelman, Felipe C. Albuquerque, M. Yashar S Kalani, Brian L. Hoh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Recent experimental evidence indicates that endogenous mechanisms against cerebral vasospasm can be induced via preconditioning. Objective: To determine whether these vascular protective mechanisms are also present in vivo in humans with aneurysmal subarachnoid hemorrhage. Methods: A multicenter retrospective cohort of patients with aneurysmal subarachnoid hemorrhage was examined for ischemic preconditioning stimulus: preexisting steno-occlusive cerebrovascular disease (CVD) and/or previous cerebral infarct. Generalized estimating equation models were performed to determine the effect of the preconditioning stimulus on the primary end points of radiographic vasospasm, symptomatic vasospasm, and vasospasm-related delayed cerebral infarction and the secondary end point of discharge modified Rankin Scale score. Results: Of 1043 patients, 321 (31%) had preexisting CVD and 437 (42%) had radiographic vasospasm. Patients with preexisting CVD were less likely to develop radiographic vasospasm (odds ratio = 0.67; 95% confidence interval = 0.489-0.930; P =.02) but had no differences in other end points. In terms of the secondary end point, patients with preexisting CVD did not differ significantly from patients without preexisting CVD in mortality or unfavorable outcome in multivariate analyses, although patients with preexisting CVD were marginally more likely to die (P =.06). Conclusion: This retrospective case-control study suggests that endogenous protective mechanisms against cerebral vasospasm-a preconditioning effect-may exist in humans, although these results could be the effect of atherosclerosis or some combination of preconditioning and atherosclerosis. Additional studies investigating the potential of preconditioning in aneurysmal subarachnoid hemorrhage are warranted.

Original languageEnglish (US)
Pages (from-to)351-358
Number of pages8
JournalNeurosurgery
Volume74
Issue number4
DOIs
StatePublished - 2014

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Cerebrovascular Disorders
Intracranial Vasospasm
Subarachnoid Hemorrhage
Preexisting Condition Coverage
Atherosclerosis
Ischemic Preconditioning
Cerebral Infarction
Blood Vessels
Case-Control Studies
Multivariate Analysis
Odds Ratio
Confidence Intervals
Mortality

Keywords

  • Aneurysm
  • Preconditioning
  • Subarachnoid Hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Kim, Y. W., Zipfel, G. J., Ogilvy, C. S., Pricola, K. L., Welch, B. G., Shakir, N., ... Hoh, B. L. (2014). Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery, 74(4), 351-358. https://doi.org/10.1227/NEU.0000000000000282

Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. / Kim, Young Woo; Zipfel, Gregory J.; Ogilvy, Christopher S.; Pricola, Katie L.; Welch, Babu G.; Shakir, Nabeel; Patel, Bhuvic; Reavey-Cantwell, John F.; Kelman, Craig R.; Albuquerque, Felipe C.; Kalani, M. Yashar S; Hoh, Brian L.

In: Neurosurgery, Vol. 74, No. 4, 2014, p. 351-358.

Research output: Contribution to journalArticle

Kim, YW, Zipfel, GJ, Ogilvy, CS, Pricola, KL, Welch, BG, Shakir, N, Patel, B, Reavey-Cantwell, JF, Kelman, CR, Albuquerque, FC, Kalani, MYS & Hoh, BL 2014, 'Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage', Neurosurgery, vol. 74, no. 4, pp. 351-358. https://doi.org/10.1227/NEU.0000000000000282
Kim, Young Woo ; Zipfel, Gregory J. ; Ogilvy, Christopher S. ; Pricola, Katie L. ; Welch, Babu G. ; Shakir, Nabeel ; Patel, Bhuvic ; Reavey-Cantwell, John F. ; Kelman, Craig R. ; Albuquerque, Felipe C. ; Kalani, M. Yashar S ; Hoh, Brian L. / Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. In: Neurosurgery. 2014 ; Vol. 74, No. 4. pp. 351-358.
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abstract = "Background: Recent experimental evidence indicates that endogenous mechanisms against cerebral vasospasm can be induced via preconditioning. Objective: To determine whether these vascular protective mechanisms are also present in vivo in humans with aneurysmal subarachnoid hemorrhage. Methods: A multicenter retrospective cohort of patients with aneurysmal subarachnoid hemorrhage was examined for ischemic preconditioning stimulus: preexisting steno-occlusive cerebrovascular disease (CVD) and/or previous cerebral infarct. Generalized estimating equation models were performed to determine the effect of the preconditioning stimulus on the primary end points of radiographic vasospasm, symptomatic vasospasm, and vasospasm-related delayed cerebral infarction and the secondary end point of discharge modified Rankin Scale score. Results: Of 1043 patients, 321 (31{\%}) had preexisting CVD and 437 (42{\%}) had radiographic vasospasm. Patients with preexisting CVD were less likely to develop radiographic vasospasm (odds ratio = 0.67; 95{\%} confidence interval = 0.489-0.930; P =.02) but had no differences in other end points. In terms of the secondary end point, patients with preexisting CVD did not differ significantly from patients without preexisting CVD in mortality or unfavorable outcome in multivariate analyses, although patients with preexisting CVD were marginally more likely to die (P =.06). Conclusion: This retrospective case-control study suggests that endogenous protective mechanisms against cerebral vasospasm-a preconditioning effect-may exist in humans, although these results could be the effect of atherosclerosis or some combination of preconditioning and atherosclerosis. Additional studies investigating the potential of preconditioning in aneurysmal subarachnoid hemorrhage are warranted.",
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AU - Kim, Young Woo

AU - Zipfel, Gregory J.

AU - Ogilvy, Christopher S.

AU - Pricola, Katie L.

AU - Welch, Babu G.

AU - Shakir, Nabeel

AU - Patel, Bhuvic

AU - Reavey-Cantwell, John F.

AU - Kelman, Craig R.

AU - Albuquerque, Felipe C.

AU - Kalani, M. Yashar S

AU - Hoh, Brian L.

PY - 2014

Y1 - 2014

N2 - Background: Recent experimental evidence indicates that endogenous mechanisms against cerebral vasospasm can be induced via preconditioning. Objective: To determine whether these vascular protective mechanisms are also present in vivo in humans with aneurysmal subarachnoid hemorrhage. Methods: A multicenter retrospective cohort of patients with aneurysmal subarachnoid hemorrhage was examined for ischemic preconditioning stimulus: preexisting steno-occlusive cerebrovascular disease (CVD) and/or previous cerebral infarct. Generalized estimating equation models were performed to determine the effect of the preconditioning stimulus on the primary end points of radiographic vasospasm, symptomatic vasospasm, and vasospasm-related delayed cerebral infarction and the secondary end point of discharge modified Rankin Scale score. Results: Of 1043 patients, 321 (31%) had preexisting CVD and 437 (42%) had radiographic vasospasm. Patients with preexisting CVD were less likely to develop radiographic vasospasm (odds ratio = 0.67; 95% confidence interval = 0.489-0.930; P =.02) but had no differences in other end points. In terms of the secondary end point, patients with preexisting CVD did not differ significantly from patients without preexisting CVD in mortality or unfavorable outcome in multivariate analyses, although patients with preexisting CVD were marginally more likely to die (P =.06). Conclusion: This retrospective case-control study suggests that endogenous protective mechanisms against cerebral vasospasm-a preconditioning effect-may exist in humans, although these results could be the effect of atherosclerosis or some combination of preconditioning and atherosclerosis. Additional studies investigating the potential of preconditioning in aneurysmal subarachnoid hemorrhage are warranted.

AB - Background: Recent experimental evidence indicates that endogenous mechanisms against cerebral vasospasm can be induced via preconditioning. Objective: To determine whether these vascular protective mechanisms are also present in vivo in humans with aneurysmal subarachnoid hemorrhage. Methods: A multicenter retrospective cohort of patients with aneurysmal subarachnoid hemorrhage was examined for ischemic preconditioning stimulus: preexisting steno-occlusive cerebrovascular disease (CVD) and/or previous cerebral infarct. Generalized estimating equation models were performed to determine the effect of the preconditioning stimulus on the primary end points of radiographic vasospasm, symptomatic vasospasm, and vasospasm-related delayed cerebral infarction and the secondary end point of discharge modified Rankin Scale score. Results: Of 1043 patients, 321 (31%) had preexisting CVD and 437 (42%) had radiographic vasospasm. Patients with preexisting CVD were less likely to develop radiographic vasospasm (odds ratio = 0.67; 95% confidence interval = 0.489-0.930; P =.02) but had no differences in other end points. In terms of the secondary end point, patients with preexisting CVD did not differ significantly from patients without preexisting CVD in mortality or unfavorable outcome in multivariate analyses, although patients with preexisting CVD were marginally more likely to die (P =.06). Conclusion: This retrospective case-control study suggests that endogenous protective mechanisms against cerebral vasospasm-a preconditioning effect-may exist in humans, although these results could be the effect of atherosclerosis or some combination of preconditioning and atherosclerosis. Additional studies investigating the potential of preconditioning in aneurysmal subarachnoid hemorrhage are warranted.

KW - Aneurysm

KW - Preconditioning

KW - Subarachnoid Hemorrhage

KW - Vasospasm

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