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Vasospasm of the basilar artery following spontaneous SAH—clinical observations and implications for vascular research

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Abstract

The basilar artery (BA), as a reference vessel for laboratory investigations of cerebral vasospasm (CVS) in many experimental models, warrants a sufficient blood supply despite hemodynamic changes during CVS. In a prospective evaluation study, we analyzed  patients who were admitted to our department with subarachnoid hemorrhage (SAH) for the occurrence and sequelae of CVS. Specifically, we sought to identify patients with CVS of the BA. As per institutional protocol, all patients with CVS detected in the posterior circulation had magnetic resonance imaging (MRI) examinations instead of CTA. Between January and December 2016, 74 patients were treated for spontaneous SAH. CVS occurred in 45 (61%) patients, and 31 (42%) patients developed associated cerebral infarctions (CI). CVS was significantly associated with CI (p < 0.0001; OR 44). In 18 (24.3%) patients, CVS significantly affected the basilar artery. Poor admission clinical state, younger age, and treatment modalities were significantly associated with BACVS. BACVS was more often detected in patients with severe CVS (p < 0.046; OR 4.4). Patients with BACVS developed cerebral infarction in a frequency comparable to other patients with CVS (61% vs. 70%, p = 0.7), but none of these infarctions occurred in the brain stem or pons even though vessel diameter was dramatically reduced according to CT- and/or MR-angiography. BACVS does not appear to be followed by cerebral infarction in the BA territory, presumably due to a vascular privilege of this vessel and its perforating branches. In contrast, brain ischemia can frequently be observed in the territories of other major arteries affected by CVS.

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References

  1. Al-mufti F, Roh D, Lahiri S, et al. (2016) Ultra-early angiographic vasospasm associated with delayed cerebral ischemia and infarction following aneurysmal subarachnoid hemorrhage. J Neurosurg 1–7

  2. Andreasen TH, Bartek J, Andresen M, Springborg JB, Romner B (2013) Modifiable risk factors for aneurysmal subarachnoid hemorrhage. Stroke 44(12):3607–3612

    Article  Google Scholar 

  3. Badjatia N, Seres D, Carpenter A, Schmidt JM, Lee K, Mayer SA, Claassen J, Connolly ES, Elkind MS (2012) Free fatty acids and delayed cerebral ischemia after subarachnoid hemorrhage. Stroke 43(3):691–696

    Article  CAS  Google Scholar 

  4. Crowley RW, Medel R, Dumont AS, Ilodigwe D, Kassell NF, Mayer SA, Ruefenacht D, Schmiedek P, Weidauer S, Pasqualin A, Macdonald RL (2011) Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke 42(4):919–923

    Article  Google Scholar 

  5. Dankbaar JW, Rijsdijk M, van der Schaaf IC, Velthuis BK, Wermer MJH, Rinkel GJE (2009) Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Neuroradiology 51(12):813–819

    Article  Google Scholar 

  6. de Rooij NK, Rinkel GJE, Dankbaar JW, Frijns CJM (2012) Delayed cerebral ischemia after subarachnoid hemorrhage: a systematic review of clinical, laboratory, and radiological predictors. Stroke 43–54

  7. Dinc N, Lescher S, Quick-Weller J, Berkefeld J, Platz J, Senft C, Seifert V, Konczalla J (2017) Outcome, prognostic factors, and follow-up results after subarachnoid hemorrhage from pericallosal artery aneurysms. World Neurosurg 99:566–571

    Article  Google Scholar 

  8. Djulejić V, Marinković S, Milić V et al (2015) Common features of the cerebral perforating arteries and their clinical significance. Acta Neurochir (Wien) 157(5):743–754

    Article  Google Scholar 

  9. Foreman B (2016) The pathophysiology of delayed cerebral ischemia. J Clin Neurophysiol 33(3)

  10. Foreman PM, Chua MH, Harrigan MR, et al (2016) External validation of the Practical Risk Chart for the prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. 1–7

  11. Ghantous CM, Azrak Z, Rahman FA, Itani HA, Zeidan A (2016) Assessment of basilar artery reactivity in stroke and subarachnoid hemorrhage using wire myograph. Methods Mol Biol 1462:625–643

    Article  CAS  Google Scholar 

  12. Güresir E, Raabe A, Jaiimsin A et al (2010) Histological evidence of delayed ischemic brain tissue damage in the rat double-hemorrhage model. J Neurol Sci 293(1-2):18–22

    Article  Google Scholar 

  13. Harteveld AA, De Cocker LJL, Dieleman N et al (2015) High-resolution postcontrast time-of-flight MR angiography of intracranial perforators at 7.0 tesla. PLoS One 10(3):1–11

    Article  Google Scholar 

  14. Hop JW, Rinkel GJ, Algra A, van Gijn J (1997) Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 28(3):660–664

    Article  CAS  Google Scholar 

  15. Jabbarli R, Reinhard M, Roelz R et al (2015) Early identification of individuals at high risk for cerebral infarction after aneurysmal subarachnoid hemorrhage: the BEHAVIOR score. J Cereb Blood Flow Metab 35(10):1587–1592

    Article  Google Scholar 

  16. Jung CS, Lange B, Zimmermann M, Seifert V (2013) CSF and serum biomarkers focusing on cerebral vasospasm and ischemia after subarachnoid hemorrhage. Stroke Res Treat 2013:560305

    PubMed  PubMed Central  Google Scholar 

  17. Konczalla J, Wanderer S, Mrosek J et al (2016) Levosimendan, a new therapeutic approach to prevent delayed cerebral vasospasm after subarachnoid hemorrhage? Acta Neurochir (Wien) 158(11):2075–2083

    Article  Google Scholar 

  18. Lescher S, Samaan T, Berkefeld J (2014) Evaluation of the pontine perforators of the basilar artery using digital subtraction angiography in high resolution and 3D rotation technique. Am J Neuroradiol 35(10):1942–1947

    Article  CAS  Google Scholar 

  19. Li G, Wang Q, Lin T (2016) Alterations in the expression of protease-activated receptor�1 and tumor necrosis factor-α in the basilar artery of rats following a subarachnoid hemorrhage. Exp Ther Med 717–722

  20. Mercier PH, Brassier G, Fournier HD, Picquet J, Papon X, Lasjaunias P (2008) Vascular microanatomy of the pontomedullary junction, posterior inferior cerebellar arteries, and the lateral spinal arteries. Interv Neuroradiol 14:49–58

    Article  CAS  Google Scholar 

  21. Otite F, Mink S, Tan CO et al (2014) Impaired cerebral autoregulation is associated with vasospasm and delayed cerebral ischemia in subarachnoid hemorrhage. Stroke 45(3):677–682

    Article  Google Scholar 

  22. Platz J, Berkefeld J, Singer OC et al (2014) Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms. Acta Neurochir (Wien) 156(11):2025–2034

    Article  Google Scholar 

  23. Platz J, Güresir E, Wagner M, Seifert V, Konczalla J (2016) Increased risk of delayed cerebral ischemia in subarachnoid hemorrhage patients with additional intracerebral hematoma. J Neurosurg 1–7

  24. Rabinstein AA, Friedman JA, Weigand SD et al (2004) Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke 35(8):1862–1866

    Article  Google Scholar 

  25. Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL (2007) Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 38(8):2315–2321

    Article  Google Scholar 

  26. Santos GA, Petersen N, Zamani AA et al (2016) Pathophysiologic differences in cerebral autoregulation after subarachnoid hemorrhage. Neurology 86(21):1950–1956

    Article  Google Scholar 

  27. Schulz UG, Fischer U (2017) Posterior circulation cerebrovascular syndromes: diagnosis and management. J Neurol Neurosurg Psychiatry 88(1):45–53

    Article  Google Scholar 

  28. Sviri GE, Britz GW, Lewis DH et al (2006) Brainstem hypoperfusion in severe symptomatic vasospasm following aneurysmal subarachnoid hemorrhage: role of basilar artery vasospasm. Acta Neurochir (Wien) 148(9):929–934

    Article  CAS  Google Scholar 

  29. Ulrich CT, Fung C, Vatter H, et al (2013) Occurrence of vasospasm and infarction in relation to a focal monitoring sensor in patients after SAH: placing a bet when placing a probe? PLoS One 8(5)

  30. van Gijn J, Kerr RS, Rinkel GJE (2007) Subarachnoid haemorrhage. Lancet 369(9558):306–318

    Article  Google Scholar 

  31. Vergouwen MDI, Ilodigwe D, MacDonald RL (2011) Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke 42(4):924–929

    Article  Google Scholar 

  32. Wagner M, Steinbeis P, Güresir E et al (2013) Beyond delayed cerebral vasospasm: infarct patterns in patients with subarachnoid hemorrhage. Clin Neuroradiol 23(2):87–95

    Article  CAS  Google Scholar 

  33. Xiong Y, Wang X, Zhong M, et al (2016) Alterations of caveolin-1 expression in a mouse model of delayed cerebral vasospasm following subarachnoid hemorrhage. Exp Ther Med 1993–2002

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Authors and Affiliations

  1. Department of Neurosurgery, Goethe University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany

    Nazife Dinc, J. Quick-Weller, J. Konczalla, M. Bruder, V. Seifert & C. Senft

  2. Department of Neuroradiology, Goethe University Hospital, Frankfurt, Germany

    S. Tritt

  3. Department of Anesthesiology, Goethe University Hospital, Frankfurt, Germany

    J. Mersmann

  4. Department of Biostatistics and Mathematical Modeling, Goethe University Hospital, Frankfurt, Germany

    E. Herrmann

Authors
  1. Nazife Dinc
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  2. J. Quick-Weller
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  3. S. Tritt
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  4. J. Konczalla
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  5. J. Mersmann
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  6. M. Bruder
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  7. E. Herrmann
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  8. V. Seifert
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  9. C. Senft
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Correspondence to Nazife Dinc.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (University Hospital Frankfurt) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Dinc, N., Quick-Weller, J., Tritt, S. et al. Vasospasm of the basilar artery following spontaneous SAH—clinical observations and implications for vascular research. Neurosurg Rev 42, 983–989 (2019). https://doi.org/10.1007/s10143-018-1015-4

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  • DOI: https://doi.org/10.1007/s10143-018-1015-4

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