of Intraarterial Administration of Fasudil Hydrochloride for Preventing Symptomatic Vasospasm After Subarachnoid Hemorrhage



Fig. 1
A representative case of vasospastic improvement after intraarterial administration of fasudil hydrochloride (IAFC). Right internal carotid angiography showed severe vasospasm in the internal carotid artery (ICA) and the anterior cerebral artery (ACA) and moderate vasospasm in the middle cerebral artery before IAFC (pre-IAFC). Angiographic vasospasm in the ICA and ACA markedly dilated in response to IAFC, and phase of the peripheral vessels distal to ACA appeared earlier after IAFC (Post-IAFC) compared with (post-IAFC)



A316735_1_En_50_Fig2_HTML.jpg


Fig. 2
A representative image of color gradient mappings of time to peak of the contrast medium. Color gradient images reconstituted from angiography of the right ICA showed that time to peak of circulating contrast medium reduced after IAFC (post-IAFC) compared with that before IAFC (pre-IAFC). The color bar shows the time scale



Table 1
Comparison of arterial circulation time with pre- and post-IAFC























 
Average (s)
P value

Pre-IAFC
2.25 ± 0.57
  

Post-IAFC
1.95 ± 0.55
0.005

Difference
0.30 ± 0.30
  





Discussion


We analyzed the arterial circulation time on DSA performed 5–7 days after the onset of SAH in 38 patients. Patients who had factors that could skew the CCT, such as elevated intracranial pressure, mean arterial pressure, abnormal CO2, or evidence of atherosclerotic stenosis or intracranial lesions, were excluded from our analysis. Our results demonstrate that arterial circulation time significantly shortened after IAFC and, in most cases, the time to peak of contrast medium reduced after IAFC. No patient developed symptomatic vasospasm after IAFC.

This single-center, retrospective study has several potential limitations. First, the number of patients was small, which means that these results should be considered to be preliminary. Second, the calculated arterial circulation time can be considered as an estimate, at best, because of the large timeframe intervals of the DSA equipment at our institution (images were acquired at 3.75 frames/s), although this method has been used and modified in previous studies on CCT [18].

The significance of arterial circulation time and the time to peak of contrast medium visualized on color gradient images has been reported previously. Prolonged circulation time is considered a measure of increased microcirculation resistance [6]. In part, this is based on the assumption that the time required by a contrast agent to pass from the cerebral arteries to the veins should be prolonged in patients with disorders of small vessels [8]. Arterial circulation time is shown to be prolonged in cases with vasospasm, poor clinical grade, or poor outcome [7, 18]. For example, similar to our observations, the findings of Ohkuma et al. indicated an inverse relationship between cerebral blood flow and arterial circulation time during vasospasm at 5–7 days after SAH and correlation between the severity of vasospasm and the arterial circulation time [6]. Our results might reflect the disturbed microcirculation caused by vasospasm and the recovery caused by reduction of microvascular resistance after IAFC.


Conclusion


IAFC significantly reduced the cerebral circulation time after aneurysmal SAH and might be effective for preventing symptomatic vasospasm after SAH.


Conflict of Interest Statement

We declare that we have no conflict of interest.

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Nov 8, 2016 | Posted by in NEUROLOGY | Comments Off on of Intraarterial Administration of Fasudil Hydrochloride for Preventing Symptomatic Vasospasm After Subarachnoid Hemorrhage

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