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Registration Number

0216U000020, 0113U000288 , R & D reports

Title

Follow-up of haemodynamic, inflammatory and immunological indices in the course of cerebral vasospasm in the acute period of intracranial arterial aneurysm rupture with the aim of treatment policy optimization

Head

Lisyany Nykolaj Ivanovich,

Registration Date

14-01-2016

Organization

State institution ''Institute of Neurosurgery n.acad. AP. Romodanov NAMS of Ukraine''

Description

Object of research - 240 patients with subarachnoid haemorrhage following an intracranial aneurysm rupture. Research objective: optimization of therapy in patients with cerebral vasospasm in the acute period of intracranial arterial aneurysm rupture depending on the character of haemodynamic disorders with due regard to the peculiarities of non-specific inflammatory and immunological processes. Methods: clinical and neurological examination with the assessment of severity of patients' condition according to WFNS, NIHSS scales, Glasgow outcome scale; neuroimaging methods: CT, multispiral CT of the brain, cerebral angiography; methods of cerebral blood flow monitoring: SPECT, ultrasonography; neurophysiological techniques: EEG; laboratory tests: biochemical studies, enzyme-linked immunoassay; statistical methods. It was established that cerebral vasospasm in the acute period of subarachnoid haemorrhage has a progredient development; its incidence according to cerebral angiography data increases from 28.4% on 1-3 days of the disease to 83.6% on 7-14 days, the development of late ischaemic complications associated with vasospasm being registered in 22.1% of cases. Consistent patterns of vasospasm development have been studied. It was established that the severity of vasospasm is defined by basal haemorrhage being massive, and the intensity of vasospasm has a significant influence on the development of delayed cerebral ischaemia. An optimal diagnostic complex for the assessment of cerebral vasospasm severity has been worked out. Predictors of severe stages of vasospasm development and likelihood of delayed cerebral ischaemia have been identified. Predictive models of vasospasm severity and ischaemic complications have been worked out. Activity markers of non-specific inflammatory processes in the acute period of aneurysm rupture have been identified, the most powerful of them being C-reactive protein and interleukin-6; their connection with the disease progression has been established. The role of nitrogen oxide in the development of pathological processes in subarachnoid haemorrhage has been confirmed. Based on the research conducted, treatment algorithm for prevention of ischaemic complications associated with cerebral vasospasm has been worked out, which contributed to the improvement of immediate treatment outcomes. The results of the research have been implemented in the clinical practice of the departments of vascular neurosurgery of SI "Acad.A.P. Romodanov Institute of Neurosurgery NAMS of Ukraine", the department of neurosurgery of CI KRC "Kyiv Regional Hospital"; Neuropathology and Neurosurgery Chair of Lviv Danylo Halytsky NMU (National Medical University) PED (Postgraduate Education Division).

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Бельська Л.М.
Ващенко В.В.
Глоба М.В.
Каменська О.І.
Макеєв С.С.
Мороз В.В.
Сидорак А.Д.
Скорохода І.І.
Цімейко О.А.
Цюбко О.І.
Чепкій Л.П.
Шуба І.М.