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Effect of recombinant streptokinase on the development of chronic cerebral vasospasm after subarachnoid hemorrhage in a swine model.
MedLine Citation:
PMID:  21311917     Owner:  NLM     Status:  Publisher    
BACKGROUND: After subarachnoid hemorrhage (SAH), the formation of subarachnoid clots and their associated resolution may be involved in the development of chronic cerebral vasospasm. To dissolve and wash out the subarachnoid clot is one of the therapeutic strategies for prevention of cerebral vasospasm. OBJECTIVE: We investigated the effect of recombinant streptokinase (r-SK), a synthetic plasminogen activator, which is added to degenerate oxyhemoglobin, one of the strongest spasmogenic substances. The efficacy and safety of this therapy concerning the development of chronic cerebral vasospasm were evaluated in a swine model. METHODS: Eighteen healthy porcine subjects were used. Each was randomly assigned to one of three groups: saline control (A), SAH treated with saline (B), and r-SK injection into the cisterna magna (C). SAH was produced by introduction of blood clots into the cisterna magna on each of 2 days in all subjects in groups B and C. At 24-h post-SAH, a one-time dosage of 15 mg of r-SK was administered to those subjects randomized to group C. Continuous drainage was applied in all three groups. Vessel diameter was evaluated by angiography before the induction of SAH and at day 7 following SAH. RESULTS: The pre- and post-SAH angiographs of subjects in group A determined no significant difference in mean vessel caliber. In group B, pre- and post-SAH angiography indicated significant (p < 0.05) reductions of the mean vessel caliber of the right internal carotid artery (ICA) and basilar artery (BA) compared with the baseline values before SAH. In the r-SK treated group, the mean percent reduction in vessel caliber of the right ICA and BA on day 7 angiograms showed no significant difference compared with the baseline value before SAH. CONCLUSIONS: Chronic cerebral vasospasm was inhibited in the animals to whom r-SK was administered for 1 day after double administration of blood clots to the cisterna magna to induce SAH. The results suggest that the post-SAH presence of subarachnoid clots that contain oxyhemoglobin might be involved in the pathogenesis of vasospasm. Further degeneration of these clots by r-SK may have a promising effect for prevention of vasospasm.
Hongzhi Xu; Xiancheng Chen; Zhiyong Qin; Yuxiang Gu; Ping Zhou
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-11
Journal Detail:
Title:  Acta neurochirurgica     Volume:  -     ISSN:  0942-0940     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Center, Wulumuqi Zhong Road 12#, Shanghai, 200040, China.
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