Nishikawa Yusuke, Yamada Shigeki, Uchida Mitsuru, Yamanaka Tomoyasu, Hayashi Yuki, Katano Hiroyuki, Tanikawa Motoki, Iwama Toru, Iihara Koji, Morioka Motohiro, Mase Mitsuhito
Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
Interfaculty Initiative in Information Studies, Institute of Industrial Science, The University of Tokyo, Tokyo, Japan.
Front Neurol. 2023 Nov 2;14:1296995. doi: 10.3389/fneur.2023.1296995. eCollection 2023.
Various prophylactic drugs for cerebral vasospasm and delayed cerebral infarction (DCI) after subarachnoid hemorrhage (SAH) have been used in Japan. To investigate the treatment trends for cerebral vasospasm and frequency of DCI after SAH throughout Japan in 2021.
In 2021 we conducted an anonymous questionnaire survey on management for preventing cerebral vasospasm after aneurysmal SAH, and the frequency of DCI. The questionnaire was emailed to 955 certified neurosurgeons at 553 hospitals in Japan. Of them, 162 hospitals (29% response rate) responded to the questionnaire. Of these, 158 were included in this study, while four hospitals that responded insufficiently were excluded. The efficacy of treatments for reducing DCI were examined through a logistic regression analysis.
Among 3,093 patients treated with aneurysmal SAH, 281 patients (9.1%) were diagnosed with DCI related to cerebral vasospasm. Coil embolization had significantly lower DCI frequency (6.9%), compared to microsurgical clipping (11.8%, odds ratio, 0.90; 95% confidential intervals, 0.84-0.96; , 0.007). In addition, cilostazol administration was associated with significantly lower DCI frequency (0.48; 0.27-0.82; 0.026). The efficacy of cilostazol in reducing DCI remained unchanged after adjustment for covariates. The most effective combination of multiple prophylactic drugs in reducing DCI related to cerebral vasospasm was cilostazol, fasudil, and statin (0.38; 0.22-0.67; 0.005).
This study elucidated the trends in prophylactic drugs to prevent cerebral vasospasm and frequency of DCI after aneurysmal SAH in Japan. Coil embolization and cilostazol administration showed effectiveness in reducing DCI related to cerebral vasospasm in 2021.
在日本，已使用多种预防蛛网膜下腔出血（SAH）后脑血管痉挛和迟发性脑梗死（DCI）的药物。本研究旨在调查2021年全日本SAH后脑血管痉挛的治疗趋势及DCI的发生频率。
2021年，我们针对动脉瘤性SAH后预防脑血管痉挛的管理及DCI的发生频率开展了一项匿名问卷调查。问卷通过电子邮件发送给日本553家医院的955名认证神经外科医生。其中，162家医院（回复率29%）回复了问卷。在这些回复的医院中，158家被纳入本研究，4家回复不充分的医院被排除。通过逻辑回归分析检验了降低DCI的治疗效果。
在3093例接受动脉瘤性SAH治疗的患者中，281例（9.1%）被诊断为与脑血管痉挛相关的DCI。与显微手术夹闭术（11.8%，优势比0.90；95%置信区间0.84 - 0.96；P = 0.007）相比，弹簧圈栓塞术的DCI发生率显著更低（6.9%）。此外，西洛他唑给药与显著更低的DCI发生率相关（0.48；0.27 - 0.82；P = 0.026）。在对协变量进行调整后，西洛他唑降低DCI的疗效保持不变。在降低与脑血管痉挛相关的DCI方面，多种预防性药物最有效的组合是西洛他唑、法舒地尔和他汀类药物（0.38；0.22 - 0.67；P = 0.005）。
本研究阐明了日本预防动脉瘤性SAH后脑血管痉挛的预防性药物趋势及DCI的发生频率。2021年，弹簧圈栓塞术和西洛他唑给药在降低与脑血管痉挛相关的DCI方面显示出有效性。
