title: Rise in serum soluble intercellular adhesion molecule-1 levels with vasospasm following aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Proinflammatory adhesion molecule expression has been demonstrated to be elevated in patients with aneurysmal subarachnoid hemorrhage (SAH). Recent studies have shown that elevations in soluble intercellular adhesion molecule-1 (ICAM-1) may be predictive of poor outcome in patients with good grade (Hunt and Hess Grades 1-2) aneurysmal SAH at delayed time points that correspond with the risk period for cerebral vasospasm. In addition, ICAM-1 is upregulated in experimental models of vasospasm. Unfortunately, the relationship of adhesion molecule expression to human vasospasm remains unclear. The authors hypothesized that the delayed elevation of soluble ICAM-1 in patients with aneurysmal SAH is associated with the development of cerebral vasospasm.
  
  
  METHODS
  Eighty-nine patients with aneurysmal SAH were prospectively enrolled in a study and stratified according to the presence or absence of vasospasm, as evidenced by daily monitoring of transcranial Doppler (TCD) velocities (presence, > 200 cm/second; absence, < 120 cm/second). Levels of soluble ICAM-1 were determined using enzyme-linked immunosorbent assay every other day for 12 days post-SAH. An analysis of covariance model was used to evaluate trends in soluble ICAM-1 levels from 2 days prior to 6 days after the occurrence of documented vasospasm. Two groups of patients, matched for admission admission Hunt and Hess grade, were compared: nine patients with TCD velocities greater than 200 cm/second and nine patients with TCD velocities less than 120 cm/second. From among the patients with TCD velocities greater than 200 cm/second six patients with angiographically documented vasospasm were selected. Patients with TCD velocities less than 120 cm/second and matched admission Hunt and Hess grades but without angiographically documented vasospasm were selected. Patients with TCD-demonstrated vasospasm showed a significant mean rate of rise (p < 0.01) in soluble ICAM-1 levels during the perivasospasm period, but admission Hunt and Hess grade-matched control patients did not (p = not significant [NS]). There was a significant difference between these groups' rates of soluble ICAM increase (p < 0.01). Patients with both TCD- and angiographically demonstrated vasospasm likewise showed a highly significant mean rate of increase in soluble ICAM-1 levels during the perivasospasm period (p < 0.01), whereas admission Hunt and Hess grade-matched controls did not (p = NS). The difference beween these groups' rates of increase was highly significant (p < 0.001).
  
  
  CONCLUSIONS
  These data suggest a role for ICAM-1 in the pathophysiology of cerebral vasospasm or its ischemic sequelae. As this relationship is further elucidated, adhesion molecules such as ICAM-1 may provide novel therapeutic targets in the prevention of vasospasm or its ischemic consequences.
authors.affiliation: Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.forename: Willlam J
authors.initials: WJ
authors.lastname: Mack
authors.forename: Grace H
authors.initials: GH
authors.lastname: Kim
authors.forename: Alan P
authors.initials: AP
authors.lastname: Lozier
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Kreiter
authors.forename: Robert R
authors.initials: RR
authors.lastname: Sciacca
authors.forename: Robert A
authors.initials: RA
authors.lastname: Solomon
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012995:Solubility; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000175:diagnosis; D015854:Up-Regulation; D020301:Vasospasm, Intracranial / Q000097:blood* / Q000175:diagnosis
chemical_list: D018799:Intercellular Adhesion Molecule-1