Journal article
Acute Effect of Intravenous Sildenafil on Cerebral Blood Flow in Patients with Vasospasm After Subarachnoid Hemorrhage
Neurocritical care, Vol.25(2), pp.201-204
10/2016
DOI: 10.1007/s12028-016-0243-0
PMCID: PMC5010798
PMID: 26940913
Abstract
The phosphodiesterase-5 inhibitor sildenafil has been shown to attenuate delayed cerebral ischemia (DCI) and improve neurologic function in experimental subarachnoid hemorrhage (SAH). We recently demonstrated that it could improve cerebral vasospasm (CVS) in humans after SAH. However, successful therapies for DCI must also restore cerebral blood flow (CBF) and/or autoregulatory capacity. In this study, we tested the effects of sildenafil on CBF in SAH patients at-risk for DCI.Six subjects with angiographically confirmed CVS received 30-mg of intravenous sildenafil (mean 9 ± 2 days after aneurysmal SAH). Each underwent 15O-PET imaging to measure global and regional CBF at baseline and post-sildenafil.Mean arterial pressure declined by 10 mm Hg on average post-sildenafil (8 %, p = 0.01), while ICP was unchanged. There was no change in global CBF (mean 34.5 ± 7 ml/100g/min at baseline vs. 33.9 ± 8.0 ml/100g/min post-sildenafil, p = 0.84). The proportion of brain regions with low CBF (<25 ml/100g/min) was also unchanged after sildenafil infusion.Infusion of sildenafil does not lead to a change in global or regional perfusion despite a significant reduction in cerebral perfusion pressure. While this could reflect the ineffectiveness of sildenafil-induced proximal vasodilatation to alter brain perfusion, it also suggests that cerebral autoregulatory function was preserved in this group. Future studies should assess whether sildenafil can restore or enhance autoregulation after SAH.
Details
- Title: Subtitle
- Acute Effect of Intravenous Sildenafil on Cerebral Blood Flow in Patients with Vasospasm After Subarachnoid Hemorrhage
- Creators
- Rajat Dhar - Division of Neurocritical Care, Department of Neurology Washington University in St. Louis 660 S Euclid Avenue St. Louis MO 63110 USAChad Washington - Department of Neurosurgery Washington University in St. Louis St. Louis MO 63110 USAMichael Diringer - Department of Neurosurgery Washington University in St. Louis St. Louis MO 63110 USAAllyson Zazulia - Department of Radiology Washington University in St. Louis St. Louis MO 63110 USAHussain Jafri - Department of Radiology Washington University in St. Louis St. Louis MO 63110 USAColin Derdeyn - Department of Radiology Washington University in St. Louis St. Louis MO 63110 USAGregory Zipfel - Department of Neurosurgery Washington University in St. Louis St. Louis MO 63110 USA
- Resource Type
- Journal article
- Publication Details
- Neurocritical care, Vol.25(2), pp.201-204
- DOI
- 10.1007/s12028-016-0243-0
- PMID
- 26940913
- PMCID
- PMC5010798
- NLM abbreviation
- Neurocrit Care
- ISSN
- 1541-6933
- eISSN
- 1556-0961
- Publisher
- Springer US; New York
- Grant note
- SDG3440008 / American Heart Association (US) (http://dx.doi.org/10.13039/100000968) UL1 TR000448 / National Center for Advancing Translational Sciences (http://dx.doi.org/10.13039/100006108)
- Language
- English
- Date published
- 10/2016
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020657702771
Metrics
32 Record Views