Introduction: The molecular mechanisms underlying cerebral vasospasm and delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) are incompletely understood. We hypothesized that anti-angiogenic factors, such as soluble Fms-like tyrosine kinase-1 (sFlt-1) and soluble transforming growth factor ß (TGFß) co-receptor endoglin (sEng), are important contributors to their pathophysiology.
Methods: We performed a prospective study in aSAH patients and measured cerebrospinal fluid (CSF) and serum levels of sFlt-1 and sEng on post-bleed day 1 and 6 and correlated levels with incidence and severity of cerebral vasospasm and DCI.
Results: Twenty-seven patients were enrolled in the study. Severe angiographic vasospasm was present in 14.8% of patients and DCI occurred in 33.3%. Elevated serum sFlt-1 on post-bleed day 1 was found to predict the development of severe angiographic vasospasm with an area under the curve (AUC) of 0.818 at marginal significance (p = 0.0578). A serum level of sFlt-1 on post-bleed day 1 of greater than 90 pg/mL had a AUC of 0.75 to predict severe angiographic vasospasm.
Conclusions: Serum levels of sFlt1 are elevated in patients with aSAH who are at risk for vasospasm. Further studies with larger sample sizes are needed to evaluate whether sFlt1 levels may predict severe vasospasm.
Patient Care: This research may help identify patients at greater risk for vasospasm early at the time of admission.
Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of anti-angiogenic factors in vasospasm from aneurysmal subarachnoid hemorrhage.