title: The role of arterioles and the microcirculation in the development of vasospasm after aneurysmal SAH.
abstract: Cerebral vasospasm of the major cerebral arteries, which is characterized by angiographic narrowing of those vessels, had been recognized as a main contributor to delayed cerebral ischemia (DCI) in subarachnoid hemorrhage (SAH) patients. However, the CONSCIOUS-1 trial revealed that clazosentan could not improve mortality or clinical outcome in spite of successful reduction of relative risk in angiographic vasospasm. This result indicates that the pathophysiology underlying DCI is multifactorial and that other pathophysiological factors, which are independent of angiographic vasospasm, can contribute to the outcome. Recent studies have focused on microcirculatory disturbance, such as microthrombosis and arteriolar constriction, as a factor affecting cerebral ischemia after SAH. Reports detecting microthrombosis and arteriolar constriction will be reviewed, and the role of the microcirculation on cerebral ischemia during vasospasm after SAH will be discussed.
authors.affiliation: Department of Neurosurgery, Hirosaki University, 5-Zaihuchou, Hirosaki, Aomori Prefecture 036-8562, Japan.
authors.forename: Masato
authors.identifier: 0000-0001-6490-527X
authors.initials: M
authors.lastname: Naraoka
authors.affiliation: Department of Neurosurgery, Hirosaki University, 5-Zaihuchou, Hirosaki, Aomori Prefecture 036-8562, Japan.
authors.forename: Naoya
authors.identifier: 0000-0002-3665-9128
authors.initials: N
authors.lastname: Matsuda
authors.affiliation: Department of Neurosurgery, Hirosaki University, 5-Zaihuchou, Hirosaki, Aomori Prefecture 036-8562, Japan.
authors.forename: Norihito
authors.identifier: 0000-0003-3003-9160
authors.initials: N
authors.lastname: Shimamura
authors.affiliation: Department of Neurosurgery, Hirosaki University, 5-Zaihuchou, Hirosaki, Aomori Prefecture 036-8562, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Asano
authors.affiliation: Department of Neurosurgery, Hirosaki University, 5-Zaihuchou, Hirosaki, Aomori Prefecture 036-8562, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohkuma
mesh_terms: D000818:Animals; D001160:Arterioles / Q000503:physiopathology*; D002545:Brain Ischemia / Q000503:physiopathology; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology*; D020301:Vasospasm, Intracranial / Q000503:physiopathology*