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Vol. 18. Issue 1.
Pages 16-27 (January 2007)
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Vol. 18. Issue 1.
Pages 16-27 (January 2007)
Perspectivas en el tratamiento del vasospasmo cerebral inducido por hemorragia subaracnoidea
Perspectives in the treatment of subarachnoid-hemorrhage-induced cerebral vasospasm
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J. Fandino*,**,***,
, A.R. Fathi*, T. Graupner*, S. Jacob***, H. Landolt**
* Departamentos de Neurocirugía. Hospital Cantonal de Aarau. Aarau. Suiza
** Departamento de Neurocirugía. Hospital Cantonal de Aarau. Aarau. Suiza
*** Departamentos de Cuidado Intensivo. Hospital Cantonal de Aarau. Aarau. Suiza
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Resumen

El vasospasmo cerebral sigue siendo la causa más importante de invalidez y muerte posterior a la ruptura de aneurismas saculares intracerebrales. Las estrategias terapéuticas en el vasospasmo inducido por la hemorragia subaracnoidea pueden ser agrupadas en cuatro categorías a saber: 1) terapias de prevención; 2) terapias de reversión; 3) terapias para el aumento de la perfusión cerebral; y 4) terapias de neuroprotección y rescate. Estudios experimentales recientes han permitido la realización de estudios clínicos fase II que sugieren resultados positivos con medicamentos que incluyen estatinas (simvastatina y pravastatina) y antagonistas de receptores tipo A de la endotelina-1 (clasozentan). De igual manera, evidencias experimentales y clínicas han mostrado las ventajas del drenaje de líquido cefalorraquídeo, administración intratecal de donadores de óxido nítrico, y los efectos desinhibidores de la Ca2+ Protein Kinasa C (Fasudil) y catecolaminas sobre la vascularización cerebral. Este artículo resume el estado de investigación actual de posibles agentes y estrategias terapéuticas relevantes en el tratamiento del vasospasmo cerebral.

Palabras clave:
Hemorragia subaracnoidea
Vasospasmo cerebral
Angioplastia
Donadores de óxido nítrico
Estatinas
Antagonistas de los receptores de la endotelina
Abreviaturas:
ACT
ACV
ARM
CBF
CD11 a/CD18
CD11 b/CD18
DIND
EDRF
ET
ETA
ETB
HSA
ICAM-1
LCR
NA
NO
NOS
PPV
TCD
t-PA
UK
VC
VCAM-1
Summary

Cerebral vasospasm is still the most important cause of death and disability after rupture of intracranial aneurysms. The therapeutic strategies in the treatment of subarachnoid hemorrhage induced vasospasm include four groups: 1) prevention of vasospasm; 2) reversion of vasospasm; 3) improvement of cerebral perfusion; and 4) neuroprotection and rescue therapies. Recent experimental studies allowed the design of phase II clinical studies which demonstrated positive results with medications and compounds such as statins (simvastatin and pravastatin) and endothelin-1 receptor antagonists (clasozentan). Moreover, experimental and clinical evidences showed the advantages of early cerebrospinal fluid drainage, intrathecal administration of NO-donors, effects of Ca2+ protein kinase inhibitor (Fasudil) and catecholamines on the cerebral vessels. This review article summarizes the stage of investigation of these medications and therapeutic strategies which will be relevant in the treatment of cerebral vasospasm.

.. I would caution that vasospasm is still around, it is still alive and living in every neurosurgical unit. Hence my plea that our scientists not falter or lose interest for a final understanding and solution”

C.G. Drake, 19909

Key words:
Subarachnoid hemorrhage
Cerebral vasospasm
Angioplasty
NO donors
Statins
Endothelin receptors antagonists

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