Wanderer Stefan, Grüter Basil E, Strange Fabio, Sivanrupan Sivani, Di Santo Stefano, Widmer Hans Rudolf, Fandino Javier, Marbacher Serge, Andereggen Lukas
Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland.
Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3008 Bern, Switzerland.
Brain Sci. 2020 Mar 7;10(3):153. doi: 10.3390/brainsci10030153.
: Delayed cerebral vasospasm (DCVS) due to aneurysmal subarachnoid hemorrhage (aSAH) and its sequela, delayed cerebral ischemia (DCI), are associated with poor functional outcome. Endothelin-1 (ET-1) is known to play a major role in mediating cerebral vasoconstriction. Angiotensin-II-type-1-receptor antagonists such as Sartans may have a beneficial effect after aSAH by reducing DCVS due to crosstalk with the endothelin system. In this review, we discuss the role of Sartans in the treatment of stroke and their potential impact in aSAH. : We conducted a literature research of the MEDLINE PubMed database in accordance with PRISMA criteria on articles published between 1980 to 2019 reviewing: "Sartans AND ischemic stroke". Of 227 studies, 64 preclinical and 19 clinical trials fulfilled the eligibility criteria. : There was a positive effect of Sartans on ischemic stroke in both preclinical and clinical settings (attenuating ischemic brain damage, reducing cerebral inflammation and infarct size, increasing cerebral blood flow). In addition, Sartans reduced DCVS after aSAH in animal models by diminishing the effect of ET-1 mediated vasoconstriction (including cerebral inflammation and cerebral epileptogenic activity reduction, cerebral blood flow autoregulation restoration as well as pressure-dependent cerebral vasoconstriction). : Thus, Sartans might play a key role in the treatment of patients with aSAH.
动脉瘤性蛛网膜下腔出血（aSAH）所致的迟发性脑血管痉挛（DCVS）及其后遗症迟发性脑缺血（DCI）与功能预后不良相关。已知内皮素-1（ET-1）在介导脑血管收缩中起主要作用。沙坦类等血管紧张素II 1型受体拮抗剂可能通过与内皮素系统的相互作用减少aSAH后的DCVS，从而对aSAH产生有益影响。在本综述中，我们讨论了沙坦类在中风治疗中的作用及其对aSAH的潜在影响。我们按照PRISMA标准对MEDLINE PubMed数据库中1980年至2019年发表的关于“沙坦类与缺血性中风”的文章进行了文献研究。在227项研究中，64项临床前研究和19项临床试验符合纳入标准。沙坦类在临床前和临床环境中对缺血性中风均有积极作用（减轻缺血性脑损伤、减少脑炎症和梗死面积、增加脑血流量）。此外，沙坦类通过减弱ET-1介导的血管收缩作用（包括减少脑炎症和脑致痫活性、恢复脑血流自动调节以及压力依赖性脑血管收缩）降低了动物模型中aSAH后的DCVS。因此，沙坦类可能在aSAH患者的治疗中起关键作用。
