Prevention of Cerebral Ischemia with Vasospasm

-Prophylactic use of Thromboxane A₂ inhibitor-

Abstract

Recent studies have demonstrated that cerebral ischemia with vasospasm is an important factor to determine outcome after rupture of intracranial aneurysm. The cerebral ischemia may be caused by decrease of prostacyclin (PGI₂) and increase of Thromboxane A₂ (TXA₂) which promote platelet aggregation and vasoconstriction.
Thromboxane A₂ inhibitor was used as preventive agent for ischemia with cerebral vasospasm. Clinical trial was made of 37 cases who had ruptured aneurysm within 7 days after subarachnoid hemorrhage. OKY-1581 (270-300mg/day) was intravenously or orally administrated about 2 weeks after admission_Patients were classified 4 Groups by Fisher's Classification. 24 cases of Group 1-3 were operated.
Outcome of 15 cases of Group 1 to 2 which show none or slight diffuse subarachnoid clot demonstrated good recovery except only one case. 10 cases of Group 3 which show clot or thick layer subarachnoid hemorrhage demonstrated excellent results except 2 cases who had neurological deficit. Ischemic signs during 2 weeks after OKY administration had not been observed in cases of Group 3 except only one case.
This case was died by severe infarction with vasospasm. These results suggest that Thromboxane A₂ inhibitor may be an effective agent as prevention of cerebral ischemia with vasospasm.