[Perspectives in the treatment of subarachnoid-hemorrhage-induced cerebral vasospasm].
Cerebral vasospasm is still the most important cause of death and disability after rupture of intracranial aneurysms. The therapeutic strategies in the treatment of subarachnoid hemorrhage induced vasospasm vasospasm include four groups: 1) prevention of vasospasm; 2) reversion of vasospasm; 3) improvement of cerebral perfusion; and 4) neuroprotection and rescue therapies. Recent experimental studies allowed the design of phase II clinical studies which demonstrated positive results with medications and compounds such as statins (simvastatin and pravastatin) and endothelin-1 receptor antagonists (clasozentan). Moreover, experimental and clinical evidences showed the advantages of early cerebrospinal fluid drainage, intrathecal administration of NO-donors, effects of Ca2+ protein kinase inhibitor (Fasudil) and catecholamines on the cerebral vessels. This review article summarizes the stage of investigation of these medications and therapeutic strategies which will be relevant in the treatment of cerebral vasospasm.
Fandino
J
J
Hospital Universitario de Berna, Universidad de Berna, Berna, Suiza.
Fathi
A R
AR
Graupner
T
T
Jacob
S
S
Landolt
H
H
D017542:Aneurysm, Ruptured / Q000150:complications; D017130:Angioplasty / Q000379:methods; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D065130:Endothelin A Receptor Antagonists; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D002532:Intracranial Aneurysm / Q000150:complications; D018696:Neuroprotective Agents / Q000627:therapeutic use; D020030:Nitric Oxide Donors / Q000627:therapeutic use; D009638:Norepinephrine / Q000494:pharmacology / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D014657:Vasculitis / Q000209:etiology / Q000517:prevention & control; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*
D000893:Anti-Inflammatory Agents; D065130:Endothelin A Receptor Antagonists; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018696:Neuroprotective Agents; D020030:Nitric Oxide Donors; D014665:Vasodilator Agents; D009638:Norepinephrine