混迷する脳血管攣縮の研究と治療

抄録

Endothelin-A receptor inhibitor (clazosentan) treatment after aneurysmal subarachnoid hemorrhage has failed to show any beneficial effects on neurological outcome, despite resolution in angiographic vasospasm, challenging the central dogma that angiographic vasospasm is the main cause of delayed ischemic neurological deficit (DIND). Many putative mechanisms have been proposed, such as microvascular disturbance, spreading cortical ischemia, early brain injury, and inflammation, to explain the cause of DIND. Consequently, recent research findings pertaining to treatment of cerebral vasospasm and DIND have been confusing and contradictory. In this review, we summarize the latest research concerning this issue and discuss the future trends in treatment strategy.