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Cerebral Hemodynamic and Metabolic Effects of Remote Ischemic Preconditioning in Patients with Subarachnoid Hemorrhage

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Cerebral Vasospasm: Neurovascular Events After Subarachnoid Hemorrhage

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 115))

Abstract

Background: Remote ischemic preconditioning (RIPC) is a form of endogenous neuroprotection induced by transient, subcritical ischemia in a distant tissue. RIPC effects on cerebral hemodynamics and metabolism have not been explored in humans. This study evaluates hemodynamic and metabolic changes induced by RIPC in patients with aneurysmal subarachnoid hemorrhage (SAH).

Methods: Patients underwent three or four RIPC sessions 2–12 days following SAH. Continuous vitals, intracranial pressure (ICP), and transcranial Doppler (TCD) data were collected. Brain microdialysis metabolic changes were monitored. ICP and TCD morphological clustering and analysis of intracranial pulse (MOCAIP) metrics were compared to positive and negative control groups for cerebral vasodilation.

Results: Seven ICP and six TCD recordings from four patients demonstrated an increase in mean ICP (8–14.57 mmHg, p < 0.05). There was a reduction in middle cerebral artery (MCA) mean velocities (111–87 cm/s, p = 0.039). ICP and TCD MOCAIP metrics demonstrated variances consistent with vasodilation that returned to baseline following the RIPC. Over the duration of the RIPC, microdialysis showed reduction in the lactate/pyruvate (L/P) ratio (42.37–33.77, p = 0.005) and glycerol (174.04–126 μg/l, p < 0.005), which persisted for 25–54 h after the last RIPC.

Conclusions: This study demonstrated cerebrovascular effects induced by RIPC consistent with transient vasodilation. Cerebral metabolic effects suggest protection from ischemia and cell membrane preservation lasting up to 2 days following RIPC.

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Acknowledgment

The Ruth and Raymond Stotter Endowed Chair in Neurosurgery (NRG) provide support for this work.

Conflicts of Interest Statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, Room 18-251 Semel, Los Angeles, CA, 90095-7039, USA

    Nestor R. Gonzalez M.D., Robert Hamilton M.S., Arzu Bilgin-Freiert M.D., Josh Dusick M.D., Paul Vespa M.D., Xiao Hu Ph.D. & Shadnaz Asgari Ph.D.

  2. Department of Radiology, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, Room 18-251 Semel, Los Angeles, CA, 90095-7039, USA

    Nestor R. Gonzalez M.D.

Authors
  1. Nestor R. Gonzalez M.D.
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  2. Robert Hamilton M.S.
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  3. Arzu Bilgin-Freiert M.D.
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  4. Josh Dusick M.D.
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  5. Paul Vespa M.D.
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  6. Xiao Hu Ph.D.
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  7. Shadnaz Asgari Ph.D.
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Corresponding author

Correspondence to Nestor R. Gonzalez M.D. .

Editor information

Editors and Affiliations

  1. , Department of Neurosurgery, University of Cincinnati, Stetson, Suite 2200 260, Cincinnati, 45267-0515, Ohio, USA

    Mario Zuccarello

  2. College of Medicine, Department of Neurology, University of Cincinnati, Albert Sabin Way 231MSB room 1, Cincinnati, 46267-0536, Ohio, USA

    Joseph F. Clark

  3. College of Medicine, Dept. of Neurology and Neurosurgery, University of Cincinnati, Albert Sabin Way 231ML0517, Cincinnati, 45267-0517, Ohio, USA

    Gail Pyne-Geithman

  4. College of Medicine, Dept. of Neurosurgery, University of Cincinnati, Stetson St. Suite 260ML0515, Cincinnati, 45219, Ohio, USA

    Norberto Andaluz

  5. College of Medicine, Dept. of Neurosurgery, University of Cincinnati, Stetson, Suite 2200 260, Cincinnati, 45219, Ohio, USA

    Jed A. Hartings

  6. , Dept. of Emergency Medicine, University of Cincinnati, Albert Sabin Way 231ML0769, Cincinnati, 45267-0769, Ohio, USA

    Opeolu M. Adeoye

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© 2013 Springer-Verlag Wien

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Gonzalez, N.R. et al. (2013). Cerebral Hemodynamic and Metabolic Effects of Remote Ischemic Preconditioning in Patients with Subarachnoid Hemorrhage. In: Zuccarello, M., Clark, J., Pyne-Geithman, G., Andaluz, N., Hartings, J., Adeoye, O. (eds) Cerebral Vasospasm: Neurovascular Events After Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 115. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1192-5_36

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  • DOI: https://doi.org/10.1007/978-3-7091-1192-5_36

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1191-8

  • Online ISBN: 978-3-7091-1192-5

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