Membrane Neovascularization and Drainage of Subdural Hematoma in a Rat Model

Wang, Dong; Jiang, Rongcai; Liu, Li; Dong, Jing; Zhang, Jian Ning

doi:10.1089/neu.2009.1057

Cited by 30 publications

(18 citation statements)

References 47 publications

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“…The findings of this trial support our early observations in animal models that atorvastatin reduces hematomas, primarily by suppressing local inflammation. [12][13][14] Inflammation at the site of the hematoma has been widely reported to disrupt the endothelial cell barrier, leading to the formation of "leaky vessels." 13,14 Atorvastatin has been reported to promote angiogenesis in models of stroke and brain injury.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients

Jiang¹,

et al. 2018

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IMPORTANCE Chronic subdural hematoma (CSDH) is a trauma-associated condition commonly found in elderly patients. Surgery is currently the treatment of choice, but it carries a significant risk of recurrence and death. Nonsurgical treatments remain limited and ineffective. Our recent studies suggest that atorvastatin reduces hematomas and improves the clinical outcomes of patients with CSDH.OBJECTIVE To investigate the safety and therapeutic efficacy of atorvastatin to nonsurgically treat patients with CSDH. DESIGN, SETTING, AND PARTICIPANTSThe Effect of Atorvastatin on Chronic Subdural Hematoma (ATOCH) randomized, placebo-controlled, double-blind phase II clinical trial was conducted in multiple centers in China from February 2014 to November 2015. For this trial, we approached 254 patients with CSDH who received a diagnosis via a computed tomography scan; of these, 200 (78.7%) were enrolled because 23 patients (9.1%) refused to participate and 31 (12.2%) were disqualified.INTERVENTIONS Patients were randomly assigned to receive either 20 mg of atorvastatin or placebo daily for 8 weeks and were followed up for an additional 16 weeks. MAIN OUTCOMES AND MEASURESThe primary outcome was change in hematoma volume (HV) by computed tomography after 8 weeks of treatment. The secondary outcomes included HV measured at the 4th, 12th, and 24th weeks and neurological function that was evaluated using the Markwalder grading scale/Glasgow Coma Scale and the Barthel Index at the 8th week.RESULTS One hundred ninety-six patients received treatment (169 men [86.2%]; median [SD] age, 63.6 [14.2] years). The baseline HV and clinical presentations were similar between patients who were taking atorvastatin (98 [50%]) and the placebo (98 [50%]). After 8 weeks, the HV reduction in patients who were taking atorvastatin was 12.55 mL more than those taking the placebo (95% CI, 0.9-23.9 mL; P = .003). Forty-five patients (45.9%) who were taking atorvastatin significantly improved their neurological function, but only 28 (28.6%) who were taking the placebo did, resulting in an adjusted odds ratio of 1.957 for clinical improvements (95% CI, 1.07-3.58; P = .03). Eleven patients (11.2%) who were taking atorvastatin and 23 (23.5%) who were taking the placebo underwent surgery during the trial for an enlarging hematoma and/or a deteriorating clinical condition (hazard ratio, 0.47; 95% CI, 0.24-0.92; P = .03). No significant adverse events were reported.CONCLUSIONS AND RELEVANCE Atorvastatin may be a safe and efficacious nonsurgical alternative for treating patients with CSDH.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients

Jiang¹,

et al. 2018

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“…Chronic subdural hematoma (CSDH) is a common neurosurgical condition that can occur from acute subdural hematoma and subdural hygroma. It can injure venous vessels or promote aberrant angiogenesis, leading to the development of so‐called leaky vessels to form hematoma . CSDH primarily occurs in the elderly but can also develop in children in rare cases.…”

Section: Clinical and Demographic Characteristics Of Four Patientsmentioning

confidence: 99%

Treatment of Relapsed Chronic Subdural Hematoma in Four Young Children with Atorvastatin and Low‐dose Dexamethasone

Huang

Zhang

et al. 2019

Pharmacotherapy

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Chronic subdural hematoma (CSDH) can develop in children in rare cases. Burr‐hole drainage (BHD) is the treatment of choice, but it is associated with a high rate of recurrence. This report describes four cases of pediatric patients (1–7 yrs of age) with post‐BHD relapsed CSDH who were successfully treated with a drug regimen that included 2.5–5 mg atorvastatin daily combined with dexamethasone with stepwise‐decreasing dosing for a total of 4 weeks. After 4 weeks of treatment, the hematoma was completely resolved in three patients and significantly reduced in one patient. During the treatment, no patient reported clinically significant adverse events. No patient experienced hematoma relapse during the follow‐up period that lasted for up to 4 years. This case report suggests the need for a randomized placebo‐controlled trial to evaluate this drug regimen for nonsurgical treatment of patients with relapsed CSDH.

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“…Despite the relative frequency of these pathologies they are comparatively poorly studied, perhaps as a result of their primary management being neurosurgical evacuation. Nonetheless, several models have been reported that largely depend upon the introduction of autologous blood to the subdural or epidural space in rodents or larger animals (Ganz and Zwetnow, 1988; Miller et al, 1990; Tsuchida and Bullock, 1995; Sasaki and Dunn, 2001; Balikci et al, 2008; Wang et al, 2010). One group simulated the compressive effects of epidural hematoma in dogs using an inflatable balloon within the epidural space (Ebmeyer et al, 1998).…”

Section: Models Ofacute Hematomamentioning

confidence: 99%