title: ω-3 Fatty Acids Ethyl Esters Suppress Cerebral Vasospasm and Improve Clinical Outcome Following Aneurysmal Subarachnoid Hemorrhage.
abstract: OBJECTIVE
  Occurrence of cerebral vasospasm after onset of aneurysmal subarachnoid hemorrhage (SAH) is a critical factor determining clinical prognosis. Eicosapentaenoic acid and docosahexaenoic acid, both ω-3 fatty acids (ω-3FA), can suppress cerebral vasospasm, and docosahexaenoic acid can relax vessel vasoconstriction and have neuroprotective effects. We investigated whether administration of ω-3FA prevented cerebral vasospasm occurrence and improved clinical outcomes after aneurysmal SAH.
  
  
  METHODS
  From 2012 to 2015, 100 consecutive patients with aneurysmal SAH were divided into 2 periods. Between 2012 and 2013 (control period), 45 patients received standard management. Between 2014 and 2015 (ω-3FA period), 55 patients were prospectively treated with additional ω-3FA. Occurrence of cerebral vasospasm, occurrence of cerebral infarction caused by vasospasm, and modified Rankin Scale scores at 30 days and 90 days after onset of SAH for each period were evaluated and compared.
  
  
  RESULTS
  The frequency of angiographic cerebral vasospasm in the ω-3FA period was significantly lower than in the control period (12 patients vs. 23 patients, P = 0.004). The frequency of new infarction caused by vasospasm in the ω-3FA period was also significantly lower than in the control period (5 patients vs. 14 patients, P = 0.011). There was a significant difference in modified Rankin Scale scores at 90 days after onset of SAH between the groups (P = 0.031). No adverse events were associated with ω-3FA administration.
  
  
  CONCLUSIONS
  Administration of ω-3FA after aneurysmal SAH may reduce the frequency of cerebral vasospasm and may improve clinical outcomes.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan. Electronic address: nakagawa@naramed-u.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Omoto
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeshima
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Matsuda
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nishimura
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yokota
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Motoyama
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Young-Su
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D016718:Arachidonic Acid / Q000097:blood; D016022:Case-Control Studies; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D002849:Chromatography, Gas; D004281:Docosahexaenoic Acids / Q000097:blood / Q000627:therapeutic use*; D015118:Eicosapentaenoic Acid / Q000097:blood / Q000627:therapeutic use*; D004952:Esters; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D065386:Historically Controlled Study; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy*; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control*
chemical_list: D004952:Esters; D015525:Fatty Acids, Omega-3; D004281:Docosahexaenoic Acids; D016718:Arachidonic Acid; D015118:Eicosapentaenoic Acid
keywords: Aneurysmal subarachnoid hemorrhage; Cerebral infarction; Cerebral vasospasm; Docosahexaenoic acid; ω-3 fatty acid