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Neurocritical Care
Published in: Neurocritical Care 1/2020

01-02-2020 | Subarachnoid Hemorrhage | Review Article

Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: Experimental-Clinical Disconnect and the Unmet Need

Authors: Fumiaki Oka, David Y. Chung, Michiyasu Suzuki, Cenk Ayata

Published in: Neurocritical Care | Issue 1/2020

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Abstract

Background

Delayed cerebral ischemia (DCI) is among the most dreaded complications following aneurysmal subarachnoid hemorrhage (SAH). Despite advances in neurocritical care, DCI remains a significant cause of morbidity and mortality, prolonged intensive care unit and hospital stay, and high healthcare costs. Large artery vasospasm has classically been thought to lead to DCI. However, recent failure of clinical trials targeting vasospasm to improve outcomes has underscored the disconnect between large artery vasospasm and DCI. Therefore, interest has shifted onto other potential mechanisms such as microvascular dysfunction and spreading depolarizations. Animal models can be instrumental in dissecting pathophysiology, but clinical relevance can be difficult to establish.

Methods

Here, we performed a systematic review of the literature on animal models of SAH, focusing specifically on DCI and neurological deficits.

Results

We find that dog, rabbit and rodent models do not consistently lead to DCI, although some degree of delayed vascular dysfunction is common. Primate models reliably recapitulate delayed neurological deficits and ischemic brain injury; however, ethical issues and cost limit their translational utility.

Conclusions

To facilitate translation, clinically relevant animal models that reproduce the pathophysiology and cardinal features of DCI after SAH are urgently needed.
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Metadata
Title
Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: Experimental-Clinical Disconnect and the Unmet Need
Authors
Fumiaki Oka
David Y. Chung
Michiyasu Suzuki
Cenk Ayata
Publication date
01-02-2020
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2020
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-018-0650-5

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