Article Text
Abstract
Delayed cerebral ischemia (DCI) affects 30% of patients following aneurysmal subarachnoid hemorrhage (aSAH) and is a major driver of morbidity, mortality, and intensive care unit length of stay for these patients. DCI is strongly associated with cerebral arterial vasospasm, reduced cerebral blood flow and cerebral infarction. The current standard treatment with intravenous or intra-arterial calcium channel antagonist and balloon angioplasty or stent has limited efficacy. A simple treatment such as a cervical sympathetic block (CSB) may be an effective therapy but is not routinely performed to treat vasospasm/DCI. CSB consists of injecting local anesthetic at the level of the cervical sympathetic trunk, which temporarily blocks the innervation of the cerebral arteries to cause arterial vasodilatation. CSB is a local, minimally invasive, low cost and safe technique that can be performed at the bedside and may offer significant advantages as complementary treatment in combination with more conventional neurointerventional surgery interventions. We reviewed the literature that describes CSB for vasospasm/DCI prevention or treatment in humans after aSAH. The studies outlined in this review show promising results for a CSB as a treatment for vasospasm/DCI. Further research is required to standardize the technique, to explore how to integrate a CSB with conventional neurointerventional surgery treatments of vasospasm and DCI, and to study its long-term effect on neurological outcomes.
- Aneurysm
- Blood Flow
- Cervical
- CT perfusion
- CT Angiography
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Footnotes
Twitter @Marco_Pileggi, @JeremyHeitMDPHD
Contributors Study conception: AMB and JJH. Systematic literature search and update: librarian non co-author. Selection of citations and articles for eligibility: AMB, JJH. Data extraction: AMB. Data analysis/interpretation: AMB, JJH. Drafting of paper: AMB. Revising of paper: AMB, JJH, GWA, GKS, SR, MP. Preparation of illustration: SR, MP. Approval of final version: all authors. Guarantor responsible for the overall content: AMB.
Funding This work was in part supported by a generous gift to Dr Heit from the CNYL Foundation.
Competing interests GWA: consultant for Genetech, equity with iSchemaView. JJH: consultant for Medtronic, MicroVention, iSchemaView. SR: consultant for Apple Inc. GKS: consultant for Sanbio, Zeiss and Surgical Theatre; patents with Peter Lazic, US.
Provenance and peer review Commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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