• Akiko Kawano, Kazutaka Sugimoto, Sadahiro Nomura, Takao Inoue, Reo Kawano, Fumiaki Oka, Hirokazu Sadahiro, Hideyuki Ishihara, and Michiyasu Suzuki.
• Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
• Neurocrit Care. 2021 Oct 1; 35 (Suppl 2): 91-99.

BackgroundDelayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) remains an important problem with a complex pathophysiology. We used data from a single-center randomized trial to assess the effect of a phosphodiesterase inhibitor, cilostazol, in patients with aneurysmal SAH to explore the relationships of DCI with vasospasm, spreading depolarization (SD) and microcirculatory disturbance.MethodsA post hoc analysis of a single-center, prospective, randomized trial of the effect of cilostazol on DCI and SD after aneurysmal SAH was performed. From all randomized cohorts, patients who underwent both SD monitoring and digital subtraction angiography (DSA) on day 9 ± 2 from onset were included. Cerebral circulation time (CCT), which was divided into proximal CCT and peripheral CCT (as a measure of microcirculatory disturbance), was obtained from DSA. Logistic regression was conducted to determine factors associated with DCI.ResultsComplete data were available for 28 of 50 patients. Of the 28 patients, 8 (28.5%) had DCI during the study period. Multivariate analysis indicated a strong association between the number of SDs on the day DSA was performed (i.e., a delayed time point after SAH onset) and DCI (odds ratio 2.064, 95% confidence interval 1.045-4.075, P = 0.037, area under the curve 0.836), whereas the degree of angiographic vasospasm and peripheral CCT were not significant factors for DCI.ConclusionsThere is a strong association between SD and DCI. Our results suggest that SD is an important therapeutic target and a potentially useful biomarker for DCI.© 2021. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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