Advances in vasospasm treatment and prevention

Komotar, Ricardo J.; Zacharia, Brad E.; Valhora, Ricky; Mocco, J; Connolly, E. Sander

doi:10.1016/j.jns.2007.04.046

Cited by 49 publications

(31 citation statements)

References 128 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These measures include administration of nimodipine and placing a central venous catheter. 17,24,44,48 Some institutions, in an effort to reduce the blood clot burden on the cerebral vessels, will insert a lumbar drain for CSF drainage, which has been reported to have some effect on the incidence of cerebral vasospasm. 22 Once the aneurysm is secured, more aggressive forms of medical management are typically instituted after a spasm is diagnosed, such as triple-H therapy, or hyperdynamic therapy without intentional anemia.…”

mentioning

confidence: 99%

“…22 Once the aneurysm is secured, more aggressive forms of medical management are typically instituted after a spasm is diagnosed, such as triple-H therapy, or hyperdynamic therapy without intentional anemia. 26,32 Triple-H therapy improves cerebral perfusion and can improve clinical outcomes, 17,24,44,48 but it has not been definitively shown to prevent cerebral vasospasm. 24,29 The prophylactic use of triple-H therapy is typically not indicated.…”

mentioning

confidence: 99%

“…26,32 Triple-H therapy improves cerebral perfusion and can improve clinical outcomes, 17,24,44,48 but it has not been definitively shown to prevent cerebral vasospasm. 24,29 The prophylactic use of triple-H therapy is typically not indicated. 33 While triple-H therapy has been shown to be effective during the onset of vasospasm, it does not always prevent cerebral ischemia or infarction from vasospasm.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Eddleman

Hurley

Naidech

et al. 2009

FOC

View full text Add to dashboard Cite

The second leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH) is delayed cerebral ischemia due to vasospasm. Although up to 70% of patients have been shown to have angiographic evidence of vasospasm, only 20–30% will present with clinical changes, including mental status changes and neurological deficits that necessitate acute management. Endovascular capabilities have progressed to become viable options in the treatment of cerebral vasospasm. The rationale for intraarterial therapy includes the fact that morbidity and mortality rates have not changed in recent years despite optimized noninvasive medical care. In this report, the authors discuss the most common endovascular options—namely intraarterial vasodilators and transluminal balloon angioplasty—from the standpoint of mechanism, efficacy, limitations, and complications as well as the treatment algorithms for cerebral vasospasm used at our institution.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Eddleman

Hurley

Naidech

et al. 2009

FOC

View full text Add to dashboard Cite

show abstract

“…Two moderately potent TCM alkaloids, chelidonine (45, IC 50 1.4 mM), used as a cancer chemotherapeutic drug (Panzer et al, 2001), and papaverine (46, IC 50 of 2.2 mM), used for treatment of vasospasm (Komotar et al, 2007), may also have the capability to affect the CYP2C19-mediated metabolism of other drugs. Based on the present data, two TCM compounds, the noninhibitor berberine (43, IC 50 150 mM) and the weak CYP2C19 inhibitor sinomenine (47, IC 50 55 mM), are unlikely to affect the metabolism of drugs that are substrates of CYP2C19.…”

Section: Discussionmentioning

confidence: 99%

Time-Dependent Inhibition of CYP2C19 by Isoquinoline Alkaloids: In Vitro and In Silico Analysis

et al. 2015

View full text Add to dashboard Cite

The cytochrome P450 2C19 (CYP2C19) enzyme plays an important role in the metabolism of many commonly used drugs. Relatively little is known about CYP2C19 inhibitors, including compounds of natural origin, which could inhibit CYP2C19, potentially causing clinically relevant metabolism-based drug interactions. We evaluated a series (N = 49) of structurally related plant isoquinoline alkaloids for their abilities to interact with CYP2C19 enzyme using in vitro and in silico methods. We examined several common active alkaloids found in herbal products such as apomorphine, berberine, noscapine, and papaverine, as well as the previously identified mechanism-based inactivators bulbocapnine, canadine, and protopine. The IC 50 values of the alkaloids ranged from 0.11 to 210 mM, and 42 of the alkaloids were confirmed to be time-dependent inhibitors of CYP2C19. Molecular docking and three-dimensional quantitative structure-activity relationship analysis revealed key interactions of the potent inhibitors with the enzyme active site. We constructed a comparative molecular field analysis model that was able to predict the inhibitory potency of a series of independent test molecules. This study revealed that many of these isoquinoline alkaloids do have the potential to cause clinically relevant drug interactions. These results highlight the need for studying more profoundly the potential interactions between drugs and herbal products. When further refined, in silico methods can be useful in the high-throughput prediction of P450 inhibitory potential of pharmaceutical compounds.

show abstract

“…Functional outcome after subarachnoid hemorrhage (SAH) has significantly improved over the past decades but secondary complications such as delayed cerebral ischemia (DCI) continue to take their toll [1]. In fact secondary complications are major determinants of outcome in neurocritical care [2].…”

mentioning

confidence: 99%

Can Quantitative EEG Reliably Predict Deterioration from Delayed Cerebral Ischemia Secondary to Vasospasm?

Schmidt

Claassen

2011

Neurocrit Care

View full text Add to dashboard Cite

Advances in vasospasm treatment and prevention

Cited by 49 publications

References 128 publications

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm

Time-Dependent Inhibition of CYP2C19 by Isoquinoline Alkaloids: In Vitro and In Silico Analysis

Can Quantitative EEG Reliably Predict Deterioration from Delayed Cerebral Ischemia Secondary to Vasospasm?

Contact Info

Product

Resources

About