Serum von Willebrand Factor, Matrix Metalloproteinase-9, and Vascular Endothelial Growth Factor Levels Predict the Onset of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

摘要: Objective Endothelial damage and intimal proliferation occur in vasospastic cerebral arteries after subarachnoid hemorrhage (SAH). In the peripheral vasculature, endothelial increases matrix metalloproteinase-9 (MMP-9) vascular growth factor (VEGF) levels, causing neointimal proliferation. We hypothesized that serum von Willebrand (vWF) (a marker of cell death), MMP-9, VEGF levels could serve as prognostic markers predicting occurrence vasospasm. Methods Venous vWF, were prospectively measured daily, for 12 days or until onset vasospasm, 45 consecutive patients admitted with SAH (n = 38) elective aneurysm clipping (control subjects, n 7). The development transcranial Doppler flow velocities more than 180 cm/s and/or new focal neurological deficits angiographically confirmed vasospasm was considered To establish whether these specific versus ischemia, blood samples obtained from a concurrent group 42 within 24 hours stroke unrelated to SAH. Results Fifty-seven percent (22 38 patients) developed 4 11 (median, 7 d). Mean peak increased prevasospasm cohort, compared nonvasospasm cohort (vWF, 5526 +/- 929 4934 599 ng/ml, P 0.01; 705 338 438 154 0.006; VEGF, 0.12 0.06 0.023). ischemia 4645 875 250 308 0.001; 0.03 0.04 0.001) markedly lower comparison unchanged control cohort. vWF 5500 MMP 700 ng/ml each independently odds subsequent (18-, 20-, 25-fold, respectively). Conclusion preceded by levels. Increased accurately predict These factors not elevated alone separate ischemic stroke, suggesting might play role pathogenesis human