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  • Alterations in the systemic inflammatory milieu as a result of cerebral aneurysm treatment: Does modality dictate inflammatory response?

    Final Number:
    1308

    Authors:
    J Mocco MD MS; Aqeela Afzal PhD; Brain Hoh MD; Edward W. Scott PhD; E. Sander Connolly MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Subarachnoid hemorrhage (SAH) afflicts 30,000 people in the United States every year. Additionally, as SAH frequently results in devastating neurologic injury and affects a relatively young patient population, it produces a disproportionate burden on society.1 A significant portion of this morbidity results from cerebral vasospasm.2 There are two accepted modalities for the treatment of ruptured aneurysms, open surgical clipping and endovascular coiling. There currently exists substantial debate as to which modality is superior in any given ruptured aneurysm. However, it has been demonstrated in a well designed prospective trial that post-subarachnoid hemorrhage cerebral vasospasm occurs more frequently in patients who have undergone clipping than coiling.3 Cerebral vasospasm has been demonstrated to be, at least in part, a pro-inflammatory disease.2,4 Therefore, some preliminary efforts have been made to determine whether inflammatory modulation is associated with the observed difference in the occurrence of cerebral vasospasm in clipped versus coiled patients.5 In an effort to establish a clearer determination of whether there is a difference in systemic inflammatory responses to the two different treatment modalities, we examined the inflammatory profiles of unruptured, electively treated aneurysms.

    Methods: Serum samples were assessed using ELISA for IL-6, IL-8 (potent inflammatory markers implicated in vasospasm pathogenesis).

    Results: Analysis demonstrated significantly elevated levels of both cytokines in clipped aneurysm patients compared to endovascularly coiled patients. These data demonstrate that the human body experiences a more robust inflammatory response following open surgical clipping, as compared to endovascular coiling.

    Conclusions: These findings may suggest that particular inflammatory cascades could potentially contribute to the observed differences in vasospasm rates across endovascular versus surgical cohorts, possibly leading to the identification of key mediators in the pathophysiologic cascade resulting in cerebral vasospasm.

    Patient Care: These data demonstrate that the human body experiences a more robust inflammatory response following open surgical clipping, as compared to endovascular coiling. These findings may suggest that particular inflammatory cascades could potentially contribute to the observed differences in vasospasm rates across endovascular versus surgical cohorts, possibly leading to the identification of key mediators in the pathophysiologic cascade resulting in cerebral vasospasm.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the modalities for the treatment of ruptured aneurysm. 2)Describe the difference in systemic inflammatory response to the two different treatment modalities.

    References: 1. Ferro et al, 2008 2. Chaichana Kl et al, 2010 3. MacDonald et al, 2008 4. Mocco et al, 2002 5. Tam et al, 2010

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