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Testing of potential biomarkers of cerebral ischemia and vasospasm in patients with cerebral aneurysm surgery


1Department of Anesthesiology, Reanimatology and Intensive Care of Neurosurgical Patients Anesthesiology, Reanimatology and Intensive Care University Hospital Centre Zagreb

DOI: 10.22514/SV102.122015.6 Vol.10,Issue 2,December 2015 pp.89-108

Published: 14 December 2015

*Corresponding Author(s): JELENA RADONIC E-mail:


Biomarkers for the prediction of vasospasm and delayed cerebral ischemia in patients with a ruptured cerebral aneurysm could be helpful.

In this prospective clinical study, endothelin-1, lactate, pCO2, and pO2 were measured in arterial and internal jugular vein blood before, during and after surgical treatment of a cerebral aneurysm, and were tested as potential predictors of neurologic outcome in patients.

Forty-one patients were enrolled in the study, 23 of them were operated on after aneurismal rupture with development of subarachnoid hemorrhage (SAH) and 18 patients were operated on for a nonruptured aneurysm.

All of the involved patients survived. There was no difference in neurologic outcome between those operated on with a ruptured or nonruptured aneurysm.

Endothelin-1 and lactate concentrations as well as pO2 and pCO2 from arterial and venous blood samples and their venoarterial difference did not differ between groups with and without an aneurismal rupture. Venoarterial difference of endothelin-1 concentrations on the day after surgery significantly differed between the groups with favorable and nonfavorable neurologic outcome. Other variables did not show a statistically significant difference.

Significant correlation was found between endothelin-1 and lactate concentrations, suggesting involvement of the same pathophysiological process.

Another interesting finding was lower arterial and venous pCO2 in patients with lower initial Glasgow Coma Scale (GCS) score and higher Hunt Hess score in the phase after extubation.

We can conclude that the measured biochemical parameters did not show sufficient predictive power to be useful for prediction of cerebral vasospasm and neurologic outcome in everyday clinical practice. However, some correlations that do exist between them suggest involvement of the same pathophysiological process.


cerebral aneurysm, neurosurgery, endothelin-1, biomarkers, delayed cerebral ischemia

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JELENA RADONIC,DUNJA ROGIC,RADOVAN RADONIC,TAMARA MURSELOVIC,VASILIJE STAMBOLIJA,JADRANKA KATANCIC,MARIN LOZIC,LJILJANA POPOVIC. Testing of potential biomarkers of cerebral ischemia and vasospasm in patients with cerebral aneurysm surgery. Signa Vitae. 2015. 10(2);89-108.


36. Teasdale G, Jennett B. Assesment of coma and impaired consciousness. Lancet 1974;2:81-4.

37. Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 1976;34:45-55.

38. Vergouwen MDI, Vermeulen M, Gijn JV, Rinkel GJE, Wijdicks EF, Muizelaar JP, et al. Definition of delayed cerebral ischemia after aneurismal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies.Stroke 2010;41:2391–5.

39. Toffaletti JG. Blood lactate: biochemistry, laboratory methods, and clinical interpretation. Crit Rev Clin Lab Sci 1991;28:253-68.

40. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet


41. Rankin L. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200 –15.

42. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van GJ. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–7.

43. Banks JL , Marotta CA . Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 2007 Mar;38(3):1091-6.

44. Kozniewska E, Michalik R, Rafalowska J, Gadamski R, Walski M, Frontczak-Baniewicz M, et al. Mechanisms of vascular dysfunction after subarachnoid hemorrhage. J Physiol Pharmacol 2006;57(Suppl 11):145–60.

45. Stein SC, Levine JM, Nagpal S, LeRoux PD. (2006) Vasospasm as the sole cause of cerebral ischemia: how strong is the evidence? Neurosurg Focus 2006;21:E2.

46. Weidauer S, Vatter H, Beck J, Raabe A, Lanfermann H, Seifert V, Zanella F. Focal laminar cortical infarcts following aneurismal subarachnoid haemorrhage. Neuroradiology 2008;50:1–8.

47. Ng WH, Moochhala S, Yeo TT, Ong PL, Ng PY. Nitric oxide and subarachnoid hemorrhage: elevated level in cerebrospinal fluid and their implications. Neurosurgery 2001;49:622-7.

48. Romano JG, Rabinstein AA, Arheart KL, Nathan S, Campo-Bustillo I, Koch S, et al. Microemboli in aneurismal subarachnoid hemorrhage. J Neuroimaging 2008;18:396–401.

49. Juvela S. Plasma endothelin concentrations after aneurysmal subarachnoid haemorrhage. J Neurosurg 2000;92:390-400.

50. Menon DK, Day D, Kuc RE, Downie AJ, Chatfield DA, Davenport AP. Arteriojugular endothelin-1 gradients in aneurysmal subarachnoid haemorrhage. Clin Sci (Lond) 2002;suppl48:399S.

51. Siman R , Giovannone N , Toraskar N , Frangos S , Stein SC , Levine JM, et al. Evidence that a panel of neurodegeneration biomarkers predicts vasospasm, infarction, and outcome in aneurismal subarachnoid hemorrhage. PLoS One 2011;6:12.

52. Mascia L, Fedorko L, Stewart DJ, Mohamed F, terBrugge K, RanieriVM, et al. Temporal relationship between endothelin-1 concentrations and cerebral vasospasm in patients with aneurismal subarachnoid hem- orrhage. Stroke 2001;32:1185–90.

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