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Markers of Endothelial Disorder after Subarachnoid Hemorrhage Sequential Changes and Impact of Open and Endovascular Surgery

Heroyuki Jimbo , Heroyuki Jimbo , Yukio Ikeda , Jo Haraoka

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International Journal of Neurology and Neurosurgery 1(2):p 109-116, July - December 2009. | DOI:

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Abstract

Objective: The goal of this study was to investigate the markers of the endothelial cell disorder after  subarachnoid hemorrhage (SAH) and the impact of open and endovascular surgery to the vasculature after SAH. Methods: 50 patients were enrolled in this prospective study. 25 patients underwent open surgery and Guglielmi detachable coil embolization, respectively. Serial blood samples were collected on post SAH days 0, 1, 7, and 14. von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), E-selectin levels were determined as markers of endothelial cell perturbation. The levels of 6-keto prostaglandin F1 alpha (6-ktPG) were measured as a marker of endothelial cell function. Results: The symptomatic vasospasm was observed in nine patients (six in open surgery and three in endovascular surgery). In both treatment strategies,the serum levels of vWF were elevated from day 0 to day 14. Serum levels of PAI-1 and E-selectin were higher in open surgery than endovascular surgery in day 7 and 14 significantly (p<0.05).The serum levels 6-ktPG were  higher in endovascular surgery than open surgery in day 4 and 7 significantly (p<0.05). Conclusion: Elevation of parameters on endothelial perurbation and coagulopathy were recognized in both procedures.The inhibition of fibrinolysis by PAI-1, theexpression of adhesion molecule, and endothelial dysfunction were  higher in open surgery than endovascular surgery. This preliminary result suggests that endothelial disorder associated with open surgical procedure may be predominant than endovascular surgery. running title: Endothelial disorder after SAH.

Keywords: endothelial disorder, subarachnoid hemorrhage, endovascular surgery, surgery, open surgery, vasospasm.

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