Aneurysmal Subarachnoid Hemorrhage, Cerebral Vasospasm
Conditions
Keywords
Nitric Oxide Consumption
Brief summary
The goal of this observational study is to understand if angiographic cerebral vasospasm (CV) can be predicted by levels of nitric oxide (NO) consumption in patients with aneurysmal subarachnoid hemorrhage (SAH). To reach this goal, the investigators will compare NO consumption levels in SAH and non-SAH patients. NO consumption levels will be analyzed from samples of participants' cerebral spinal fluid (CSF).
Detailed description
After enrollment, the investigators will collect patients' demographics and most relevant clinical characteristics of the patients. For patients with SAH, the investigators will collect an-1 ml aliquot of CSF from the drainage circuit daily, (using a sterile procedure that involves a valve of the closed system circuit located distally to the patient, before the collection container), for a period of 15 days following SAH. The samples will be stored at -80 degrees. The investigators will perform daily Transcranial Doppler (TCD) monitoring to assess whether the patients have cerebral vasospasm. In case of suspected vasospasm, and in all comatose patients after 4 days from the bleeding, a CT angiography will be performed to define the angiographic CV. For the control group, discarded 1 ml-aliquot of CSF will be collected at the time of needle insertion for spinal anesthesia. At the end of the protocol, the study population will be divided in 3 groups: * patients with SAH and vasospasm * patients with SAH and no vasospasm * control group
Interventions
None listed
Sponsors
Massachusetts General Hospital
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adult * patient with SAH and with an external ventricular drainage (EVD) placed within 24 hours after the onset of the hemorrhage
Exclusion criteria
* pregnancy * pre-existing neurological comorbidities * coagulation disorders * anemia * absence of a good cranial window to perform Transcranial Doppler (TDC) * presence of \>50% stenosis of carotid arteries confirmed by doppler ultrasound * Technical problems on EVD that prevent CSF withdrawals For the control group, we will invite to participate patients without neurological comorbidities undergoing spinal anesthesia in the operating room or with a spinal drain for major vascular surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Nitric oxide consumption | Daily for 15 days following aneurysmal subarachnoid hemorrhage; for controls, once at initiation of spinal anesthesia | Measurement taken from cerebrospinal fluid using nitric oxide consumption analyzer |
| Occurrence of cerebral vasospasm in patients with subarachnoid hemorrhage | Daily for 15 days following aneurysmal subarachnoid hemorrhage | Transcranial Doppler monitoring will provide peak systolic velocities (PSVs) at the middle (MCA), anterior (ACA), and posterior (PCA) cerebral arteries. Suspected vasospasm will be defined as a mean flow velocity \>120 cm/s and a Lindegaard ratio (LR) ≥3. The LR will be obtained by dividing the mean flow velocities of the MCA by those of ipsilateral extracranial internal carotid artery. In case of suspected vasospasm, and in all comatose patients after 4 days from the bleeding, a CT angiography will be performed to define the angiographic CV. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Nitric oxide metabolite levels | Daily for 15 days following aneurysmal subarachnoid hemorrhage; for controls, once at initiation of spinal anesthesia | Measurement taken from cerebrospinal fluid |
| Free hemoglobin | Daily for 15 days following aneurysmal subarachnoid hemorrhage; for controls, once at initiation of spinal anesthesia | Measurement taken from cerebrospinal fluid |
Countries
Italy, United States
Contacts
CONTACTLorenzo Berra, MD
PRINCIPAL_INVESTIGATORLorenzo Berra, MD
Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital
Outcome results
None listed