Effect of delayed onset prostacyclin on markers of endothelial function and damage after subarachnoid hemorrhage

• Published in: Acta neurochirurgica 2017-06, Vol.159 (6), p.1073-1078
• Main Authors: Gybel-Brask, Mikkel, Rasmussen, Rune, Stensballe, Jakob, Johansson, Pär I., Ostrowski, Sisse R.
• Format: Article
• Language: English
• Subjects: Activation; Activation analysis; Adrenal glands; Adult; Aged; Aneurysm; Aneurysms; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Bioindicators; Biomarkers; Biomarkers - blood; Cadherins; Cell activation; Clinical trials; Coiling; Degradation; Endothelium; Endothelium, Vascular - metabolism; Endovascular coiling; Enzyme-linked immunosorbent assay; Epinephrine; Epoprostenol - administration & dosage; Epoprostenol - adverse effects; Epoprostenol - therapeutic use; Female; Glycocalyx - metabolism; Hemorrhage; Humans; Interventional Radiology; Intravenous administration; Ischemia; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Noradrenaline; Norepinephrine; Original Article - Vascular; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Prostacyclin; Randomization; Short term memory; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - blood; Subarachnoid Hemorrhage - drug therapy; Surgery; Surgical Orthopedics; Sympathetic nervous system; Syndecan; Vasoconstriction
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-017-3168-2

Background Subarachnoid hemorrhage (SAH) is a neurological emergency. Delayed ischemic neurological deficit is one of the main causes of poor outcome after SAH and is probably caused, at least in part, by cerebral vasospasm. The pathophysiology of this is multifaceted, but endothelial damage and activation as well as glycocalyx damage have been implicated. Prostacyclin has been shown to protect damaged and activated endothelium and to facilitate glycocalyx repair. We investigated biomarkers of endothelial activation and damage in patients with SAH randomized to 5 days prostacyclin infusion or placebo. Methods Patients with aneurysmal SAH managed by coiling or surgery, and a World Federation of Neurological Surgeons score between 1 and 4, and Fisher grade 3 or 4, were treated with a continuous low-dose intravenous prostacyclin infusion or placebo initiated on day 5 and discontinued on day 10 after SAH. Blood samples were drawn from the patients before, during and after prostacyclin/placebo infusion. Soluble biomarkers of endothelial cell activation (sE-selectin, sVE-cadherin) and damage (sTM), glycocalyx damage (syndecan-1) and sympathoadrenal activation (adrenaline, noradrenaline), were measured by ELISA. Results Ninety patients were randomized. Prostacyclin infusion influenced neither biomarkers of sympathoadrenal activation, endothelial activation and damage nor biomarkers of endothelial glycocalyx breakdown. Conclusions We did not find any effects on markers of sympathoadrenal activation, endothelial damage and activation, or glycocalyx degradation of delayed onset prostacyclin infusion compared to placebo. Further trials investigating early onset endothelial repair using prostacyclin are warranted.