Cerebral Vasospasm: Mechanisms, Pathomorphology, Diagnostics, Treatment

Cerebral vessels constriction is one of the leading causes of mortality and disability in patients with acute cerebral circulatory disorders. The most dangerous type of acute cerebrovascular disease accompanied by high mortality is ruptured cerebral aneurysms with subarachnoidal hemorrhage (SAH). Following a constriction of the cerebral vessels on the background of SAH is the reason for brain ischemia. This chapter will focus on the mechanisms of formation of cerebral vascular spasm, pathomorphological aspects of the cerebral vessels constriction, and the stages of vascular spasm—the development of constrictive-stenotic arteriopathy, contractural degeneration of smooth muscle cells, and endothelial damage. We will cover classifications of cerebral vessels constriction by prevalence and severity, modern methods of clinical and instrumental diagnostics and treatment including paroxysmal sympathetic hyperactivity syndrome associated with the development of secondary complications, a longer stay of the patients in the ICU, higher disability and mortality.

Simultaneous radio-ulnar cannulation: shifting gears from ‘feasibility’ to ‘applicability’

Conventionally, routes of vascular access commonly include femoral and radial arteries with brachial, ulnar and subclavian arteries being rarely used for coronary interventions. Non-femoral arterial access is being increasingly preferred to minimise groin puncture site complications, prolonged immobilization and duration of hospital stay. However, radial artery cannulation is also fraught with fears of tortuosity, loops, vascular spasm, perforation, pseudoaneurysm formation, arm hematoma and arterial occlusion. In contemporary practice when most of the coronary procedures are being done via transradial access, encountering one of the above-mentioned hurdles often forces the operator to switchover to femoral access. Here, we explore the rationale, feasibility, operational logistics, clinical implications and future directions for using simultaneous radio-ulnar arterial access in the same extremity.

Intractable spasm in a hypoplastic brachioradial artery during coronary angiography. A last chance before surgery

For the past several years coronary angiography through radial artery has been preferred vascular access over femoral artery due to the favorable outcomes. However radial access has also rare drawbacks. One of the main complications of radial approach is vascular spasm. Although radial spasm can easily be resolved with various intervention, rarely it may be intractable in particular anatomic variations. These patients might be needed advanced treatment methods to overcome vasospasm. In this paper we report an intractable spasm in a hypoplastic radial artery during angiography which could only be resolved by neuraxial blockage after failure of conventional treatments.

Choosing of suitable animal model of arterial thrombosis to test new recombinant thrombolytic agent — modified human plasminogen

Растворение артериального тромба с помощью рекомбинантного белка — модифицированного плазмина человека — исследовали на живот- ной модели (бедренной артерии кролика). Опробованы различные способы моделирования артериального тромбоза, и как наиболее адекват- ный выбран способ поражения стенки сосуда путем механического повреждения артерии. При венозном тромбе введение рекомбинантного плазмина или рекомбинантной проурокиназы приводит к растворению тромба и восстанов- лению кровотока. При артериальном тромбе, полученном путем механического повреждения артерии, введение рекомбинантного плазмина или рекомбинантной проурокиназы не приводит к восстановлению кровотока в артерии кроликов из-за спазма сосуда. Введение папаверина в месте спазма устраняет спазм и восстанавливает кровоток. Это явление не описано в литературе, но служит препятствием при выборе адекватной модели артериального тромбоза Dissolution of arterial thrombus by recombinant human modified plasmin was examined in a rabbit model of femoral artery occlusion. Various ways to model arterial thrombosis have been tested. Mechanical damage to the artery was chosen as the most adequate method to model art erial thrombosis. Recombinant plasmin or prourokinase dissolve venous thrombus and restore blood flow. Due to vascular spasm these compounds fail to restore blood flow in arterial thrombosis caused by mechanical damage to the artery. Papaverin application at the site of spasm removes it and restores blood flow. This phenomenon is not described in the literature and hinders the choice of adequate model of arterial thrombosis

Experience with intraoperative infiltration anesthesia during knee replacement

Intraoperative local infiltration anesthesia significantly reduces the need for opioid anesthesia in the postoperative period, accelerates early activation and rehabilitation due to adequate analgesia, and reduces postoperative blood loss due to vascular spasm in the wound during total knee replacement. Due to the quick adaptation of patients to the joint implant, it is possible to reduce the time spent by patients in hospitals, as well as reduce the cost of treatment.

Severe Hyponatremia-Induced Stress Cardiomyopathy: A Case Report and Review of Literature

Takotsubo or stress cardiomyopathy is a non ischemic disease affecting the myocardium, which presents with typical features of myocardial ischemia. Although the presentation with acute central chest pain and shortness of breath mimics acute myocardial ischemia, there is an absence of actual disruption of cardiac blood supply via the coronaries due to acute plaque rupture or vascular spasm. The underlying pathophysiology of this clinical entity remains largely unclear, but a definite association with physical or emotional stress has been well established, hence the term “stress cardiomyopathy.” The list of potential triggers continues to grow as the disorder is increasingly detected by clinicians and cardiologists, with better clinical insight and improved availability of cardiac investigations. We report a patient with Takotsubo cardiomyopathy associated with severe hyponatremia.

The role of nimodipine and magnesium sulfate in the prevention and treatment of vascular spasm in patients in the acute rupture of cerebral aneurysms

Vascular spasm in patients with hemorrhage from rupture of cerebral aneurysms is the main cause of adverse outcomes of the disease. One way to treat persistent contraction of cerebral arteries is to use nimodipine and magnesium sulfate. This literature review presents studies on the use of nimodipine and magnesium sulfate in the treatment of vascular spasm, and highlights the main links of pathogenesis and drug action mechanisms.

Severe Prinzmetal’s Angina Inducing Ventricular Fibrillation Cardiac Arrest

Prinzmetal’s angina is a vascular spasm of the coronary artery that can mimic acute coronary syndrome. It is rarely responsible for ventricular arrhythmias and cardiac arrest; however, survivors with these complications are at increased risk for recurrent ventricular arrhythmias and sudden cardiac death. This is true despite the presence of normal cardiac function and optimal medical therapy. Thus, this select population should be considered for an implantable cardioverter defibrillator (ICD). In this case vignette, we describe a healthy 48-year-old female with ventricular fibrillation arrest, followed by recurrent ventricular tachyarrhythmias caused by Prinzmetal’s angina.