Kassell N F, Sasaki T, Colohan A R, Nazar G
Stroke. 1985 Jul-Aug;16(4):562-72. doi: 10.1161/01.str.16.4.562.
Cerebral vasospasm following aneurysmal subarachnoid hemorrhage is one of the most important causes of cerebral ischemia, and is the leading cause of death and disability after aneurysm rupture. There are two definitions of cerebral vasospasm: angiographic and clinical. Care must be exercised to be certain that it is clear which entity is being addressed. The diagnosis of the clinical syndrome is one of exclusion and can rarely be made with absolute certainty. The pathogenesis of cerebral vasospasm is poorly understood. Most current theories focus on the release of factors from the subarachnoid clot. More attention must be given to the role of endothelial damage and alterations in the blood-arterial wall barrier. The application of modern techniques for studying vascular smooth muscle which have been developed as a result of research in the areas of hypertension and atherosclerosis must be applied to the problem of cerebral vasospasm. A stress test to select patients with angiographic arterial narrowing who have adequate cerebral vascular reserve to undergo surgery should be developed. The optimal treatment of vasospasm awaits development of agents for blocking or inactivating spasmogenic substances or blocking arterial smooth muscle contraction. Rheological or hemodynamic manipulations to prevent or reverse ischemic consequences of vasospasm are relatively effective, but complicated and hazardous, and should be viewed principally as interim measures awaiting development of more specific therapies for the arterial narrowing.
动脉瘤性蛛网膜下腔出血后的脑血管痉挛是脑缺血的最重要原因之一，也是动脉瘤破裂后死亡和残疾的主要原因。脑血管痉挛有两种定义：血管造影学定义和临床定义。必须谨慎确保明确所讨论的是哪种情况。临床综合征的诊断是一种排除性诊断，很少能绝对确定。脑血管痉挛的发病机制尚不清楚。目前大多数理论集中在蛛网膜下腔血凝块中各种因子的释放。必须更加关注内皮损伤以及血 - 动脉壁屏障改变所起的作用。由于高血压和动脉粥样硬化领域的研究而开发的用于研究血管平滑肌的现代技术，必须应用于脑血管痉挛问题。应该开发一种压力测试，以筛选出具有足够脑血管储备可接受手术的血管造影显示动脉狭窄的患者。血管痉挛的最佳治疗方法有待开发出能够阻断或使致痉物质失活或阻断动脉平滑肌收缩的药物。为预防或逆转血管痉挛的缺血后果而进行的血液流变学或血流动力学操作相对有效，但复杂且有风险，主要应视为等待针对动脉狭窄开发更特异性疗法的临时措施。
