Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: A comparative study
OBJECTIVE:Statins, which improve the bioavailability of endogenous nitric oxide and upregulate endothelial nitric oxide synthase, have been used to prevent cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The objective of this study was to determine whether statin therapy diminished vaso...
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| Veröffentlicht in: | Critical care medicine 2012-02, Vol.40 (2), p.594-602 |
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| creator | Sanchez-Peña, Paola Nouet, Aurélien Clarençon, Frédéric Colonne, Chantal Jean, Betty Le Jean, Lise Fonfrede, Michèle Aout, Mounir Vicaut, Eric Puybasset, Louis |
| description | OBJECTIVE:Statins, which improve the bioavailability of endogenous nitric oxide and upregulate endothelial nitric oxide synthase, have been used to prevent cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The objective of this study was to determine whether statin therapy diminished vasospasm-induced ischemia as assessed using daily measurements of serum S100B, a biomarker for cerebral ischemia, and computed tomography measurement of ischemic lesion volume.
DESIGN:Single-center study of cases and historical controls.
SETTING:Neurointensive care unit in a university hospital.
PATIENTS:Consecutive patients with aneurysmal subarachnoid hemorrhage treated with clipping or coiling within 96 hrs of symptom onset (n = 278) were included from April 2004 to October 2007.
INTERVENTION:Oral atorvastatin, 40 mg/day for 21 days, was used routinely starting on December 1, 2005, in 142 patients, who were compared with the 136 patients managed earlier.
MEASUREMENTS AND MAIN RESULTS:Ischemic lesion size was measured using computed tomography on the last available scan and serum S100B was assayed daily for 15 days after admission. Angiographic narrowing was semiquantitatively assessed in patients with vasospasm. In the overall population, cerebral vasospasm was significantly less common in the statin-treated group. Severity of vasospasm, as assessed on the most severe angiogram, was lowered with statin. Statins significantly reduced volume of ischemia in patients with vasospasm and an uncomplicated coiling procedure. S100B levels were significantly lower in statin-treated patients, and the decrease was greatest among high-grade patients (World Federation of Neurological Surgeons 3–5). No differences were found between statin-treated and untreated groups regarding rescue therapy intensity or 1-yr clinical outcomes.
CONCLUSIONS:Atorvastatin reduces the incidence, the severity and the ischemic consequences of vasospasm as assessed on computed tomography. In high-grade World Federation of Neurological Surgeons patients, atorvastatin decreases serum levels of S100B, a biomarker of brain ischemia. Despite these positive effects on biomarkers, no improvement of outcome was seen in the overall population, although there was a tendency for a better clinical outcome in high-grade patients. |
| doi_str_mv | 10.1097/CCM.0b013e31822f05e7 |
| format | Article |
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DESIGN:Single-center study of cases and historical controls.
SETTING:Neurointensive care unit in a university hospital.
PATIENTS:Consecutive patients with aneurysmal subarachnoid hemorrhage treated with clipping or coiling within 96 hrs of symptom onset (n = 278) were included from April 2004 to October 2007.
INTERVENTION:Oral atorvastatin, 40 mg/day for 21 days, was used routinely starting on December 1, 2005, in 142 patients, who were compared with the 136 patients managed earlier.
MEASUREMENTS AND MAIN RESULTS:Ischemic lesion size was measured using computed tomography on the last available scan and serum S100B was assayed daily for 15 days after admission. Angiographic narrowing was semiquantitatively assessed in patients with vasospasm. In the overall population, cerebral vasospasm was significantly less common in the statin-treated group. Severity of vasospasm, as assessed on the most severe angiogram, was lowered with statin. Statins significantly reduced volume of ischemia in patients with vasospasm and an uncomplicated coiling procedure. S100B levels were significantly lower in statin-treated patients, and the decrease was greatest among high-grade patients (World Federation of Neurological Surgeons 3–5). No differences were found between statin-treated and untreated groups regarding rescue therapy intensity or 1-yr clinical outcomes.
CONCLUSIONS:Atorvastatin reduces the incidence, the severity and the ischemic consequences of vasospasm as assessed on computed tomography. In high-grade World Federation of Neurological Surgeons patients, atorvastatin decreases serum levels of S100B, a biomarker of brain ischemia. Despite these positive effects on biomarkers, no improvement of outcome was seen in the overall population, although there was a tendency for a better clinical outcome in high-grade patients.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e31822f05e7</identifier><identifier>PMID: 21926584</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Atorvastatin Calcium ; Biological and medical sciences ; Biomarkers - blood ; Brain Ischemia - diagnosis ; Brain Ischemia - drug therapy ; Brain Ischemia - etiology ; Case-Control Studies ; Confidence Intervals ; Critical Care - methods ; Critical Illness - mortality ; Critical Illness - therapy ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Heptanoic Acids - administration & dosage ; Hospitals, University ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage ; Intensive care medicine ; Intensive Care Units ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Nerve Growth Factors - blood ; Predictive Value of Tests ; Pyrroles - administration & dosage ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Respiratory system ; Retrospective Studies ; Risk Assessment ; S100 Calcium Binding Protein beta Subunit ; S100 Proteins - blood ; Severity of Illness Index ; Statistics, Nonparametric ; Subarachnoid Hemorrhage - complications ; Subarachnoid Hemorrhage - diagnosis ; Survival Rate ; Tomography, X-Ray Computed - methods ; Treatment Outcome ; Vasospasm, Intracranial - drug therapy ; Vasospasm, Intracranial - prevention & control</subject><ispartof>Critical care medicine, 2012-02, Vol.40 (2), p.594-602</ispartof><rights>2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3301-f4d93a2c873cf25547669fa8af2d814d43e58151a3b0577f87e5184b98385ee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25498699$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21926584$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sanchez-Peña, Paola</creatorcontrib><creatorcontrib>Nouet, Aurélien</creatorcontrib><creatorcontrib>Clarençon, Frédéric</creatorcontrib><creatorcontrib>Colonne, Chantal</creatorcontrib><creatorcontrib>Jean, Betty</creatorcontrib><creatorcontrib>Le Jean, Lise</creatorcontrib><creatorcontrib>Fonfrede, Michèle</creatorcontrib><creatorcontrib>Aout, Mounir</creatorcontrib><creatorcontrib>Vicaut, Eric</creatorcontrib><creatorcontrib>Puybasset, Louis</creatorcontrib><title>Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: A comparative study</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:Statins, which improve the bioavailability of endogenous nitric oxide and upregulate endothelial nitric oxide synthase, have been used to prevent cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The objective of this study was to determine whether statin therapy diminished vasospasm-induced ischemia as assessed using daily measurements of serum S100B, a biomarker for cerebral ischemia, and computed tomography measurement of ischemic lesion volume.
DESIGN:Single-center study of cases and historical controls.
SETTING:Neurointensive care unit in a university hospital.
PATIENTS:Consecutive patients with aneurysmal subarachnoid hemorrhage treated with clipping or coiling within 96 hrs of symptom onset (n = 278) were included from April 2004 to October 2007.
INTERVENTION:Oral atorvastatin, 40 mg/day for 21 days, was used routinely starting on December 1, 2005, in 142 patients, who were compared with the 136 patients managed earlier.
MEASUREMENTS AND MAIN RESULTS:Ischemic lesion size was measured using computed tomography on the last available scan and serum S100B was assayed daily for 15 days after admission. Angiographic narrowing was semiquantitatively assessed in patients with vasospasm. In the overall population, cerebral vasospasm was significantly less common in the statin-treated group. Severity of vasospasm, as assessed on the most severe angiogram, was lowered with statin. Statins significantly reduced volume of ischemia in patients with vasospasm and an uncomplicated coiling procedure. S100B levels were significantly lower in statin-treated patients, and the decrease was greatest among high-grade patients (World Federation of Neurological Surgeons 3–5). No differences were found between statin-treated and untreated groups regarding rescue therapy intensity or 1-yr clinical outcomes.
CONCLUSIONS:Atorvastatin reduces the incidence, the severity and the ischemic consequences of vasospasm as assessed on computed tomography. In high-grade World Federation of Neurological Surgeons patients, atorvastatin decreases serum levels of S100B, a biomarker of brain ischemia. Despite these positive effects on biomarkers, no improvement of outcome was seen in the overall population, although there was a tendency for a better clinical outcome in high-grade patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Atorvastatin Calcium</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - drug therapy</subject><subject>Brain Ischemia - etiology</subject><subject>Case-Control Studies</subject><subject>Confidence Intervals</subject><subject>Critical Care - methods</subject><subject>Critical Illness - mortality</subject><subject>Critical Illness - therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glasgow Coma Scale</subject><subject>Heptanoic Acids - administration & dosage</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nerve Growth Factors - blood</subject><subject>Predictive Value of Tests</subject><subject>Pyrroles - administration & dosage</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Respiratory system</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>S100 Calcium Binding Protein beta Subunit</subject><subject>S100 Proteins - blood</subject><subject>Severity of Illness Index</subject><subject>Statistics, Nonparametric</subject><subject>Subarachnoid Hemorrhage - complications</subject><subject>Subarachnoid Hemorrhage - diagnosis</subject><subject>Survival Rate</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><subject>Vasospasm, Intracranial - drug therapy</subject><subject>Vasospasm, Intracranial - prevention & control</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkd1u1DAQhS0EokvhDRDyDeIqZfyX2NytVvxJRVzQ-2jijJtAsllsp9U-Am-NSxcqMTfW2N_xGc1h7KWACwGuebvbfbmADoQiJayUAQw1j9hGGAUVSKcesw2Ag0ppp87Ys5S-AwhtGvWUnUnhZG2s3rBf27zEG0wZ87jnPflImChxv8yHNVPP8zIv1xEPw5HjvuffBECFqSCpPHYRi2pMfqB5RI4hU-Rp7TCiH_bL2BcNrfGYZpx4YZYYB7ymd3z7x6BgebwhnvLaH5-zJwGnRC9O5zm7-vD-avepuvz68fNue1l5pUBUQfdOofS2UT5IY3RT1y6gxSB7K3SvFRkrjEDVgWmaYBsywurOWWUNkTpnb-6_PcTl50opt3OZn6apTLqsqXWitgaMqgup70kfl5QihfYQxxnjsRXQ3kXQlgja_yMoslcng7Wbqf8n-rvzArw-AZg8TiHi3o_pgTPa2dq5B__bZSp7TT-m9ZZiOxBOeWihlJK6riQICbJ01d2NUL8BDFGhlA</recordid><startdate>201202</startdate><enddate>201202</enddate><creator>Sanchez-Peña, Paola</creator><creator>Nouet, Aurélien</creator><creator>Clarençon, Frédéric</creator><creator>Colonne, Chantal</creator><creator>Jean, Betty</creator><creator>Le Jean, Lise</creator><creator>Fonfrede, Michèle</creator><creator>Aout, Mounir</creator><creator>Vicaut, Eric</creator><creator>Puybasset, Louis</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201202</creationdate><title>Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: A comparative study</title><author>Sanchez-Peña, Paola ; Nouet, Aurélien ; Clarençon, Frédéric ; Colonne, Chantal ; Jean, Betty ; Le Jean, Lise ; Fonfrede, Michèle ; Aout, Mounir ; Vicaut, Eric ; Puybasset, Louis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3301-f4d93a2c873cf25547669fa8af2d814d43e58151a3b0577f87e5184b98385ee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Atorvastatin Calcium</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - drug therapy</topic><topic>Brain Ischemia - etiology</topic><topic>Case-Control Studies</topic><topic>Confidence Intervals</topic><topic>Critical Care - methods</topic><topic>Critical Illness - mortality</topic><topic>Critical Illness - therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glasgow Coma Scale</topic><topic>Heptanoic Acids - administration & dosage</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nerve Growth Factors - blood</topic><topic>Predictive Value of Tests</topic><topic>Pyrroles - administration & dosage</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Respiratory system</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>S100 Calcium Binding Protein beta Subunit</topic><topic>S100 Proteins - blood</topic><topic>Severity of Illness Index</topic><topic>Statistics, Nonparametric</topic><topic>Subarachnoid Hemorrhage - complications</topic><topic>Subarachnoid Hemorrhage - diagnosis</topic><topic>Survival Rate</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><topic>Vasospasm, Intracranial - drug therapy</topic><topic>Vasospasm, Intracranial - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sanchez-Peña, Paola</creatorcontrib><creatorcontrib>Nouet, Aurélien</creatorcontrib><creatorcontrib>Clarençon, Frédéric</creatorcontrib><creatorcontrib>Colonne, Chantal</creatorcontrib><creatorcontrib>Jean, Betty</creatorcontrib><creatorcontrib>Le Jean, Lise</creatorcontrib><creatorcontrib>Fonfrede, Michèle</creatorcontrib><creatorcontrib>Aout, Mounir</creatorcontrib><creatorcontrib>Vicaut, Eric</creatorcontrib><creatorcontrib>Puybasset, Louis</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sanchez-Peña, Paola</au><au>Nouet, Aurélien</au><au>Clarençon, Frédéric</au><au>Colonne, Chantal</au><au>Jean, Betty</au><au>Le Jean, Lise</au><au>Fonfrede, Michèle</au><au>Aout, Mounir</au><au>Vicaut, Eric</au><au>Puybasset, Louis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: A comparative study</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2012-02</date><risdate>2012</risdate><volume>40</volume><issue>2</issue><spage>594</spage><epage>602</epage><pages>594-602</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:Statins, which improve the bioavailability of endogenous nitric oxide and upregulate endothelial nitric oxide synthase, have been used to prevent cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The objective of this study was to determine whether statin therapy diminished vasospasm-induced ischemia as assessed using daily measurements of serum S100B, a biomarker for cerebral ischemia, and computed tomography measurement of ischemic lesion volume.
DESIGN:Single-center study of cases and historical controls.
SETTING:Neurointensive care unit in a university hospital.
PATIENTS:Consecutive patients with aneurysmal subarachnoid hemorrhage treated with clipping or coiling within 96 hrs of symptom onset (n = 278) were included from April 2004 to October 2007.
INTERVENTION:Oral atorvastatin, 40 mg/day for 21 days, was used routinely starting on December 1, 2005, in 142 patients, who were compared with the 136 patients managed earlier.
MEASUREMENTS AND MAIN RESULTS:Ischemic lesion size was measured using computed tomography on the last available scan and serum S100B was assayed daily for 15 days after admission. Angiographic narrowing was semiquantitatively assessed in patients with vasospasm. In the overall population, cerebral vasospasm was significantly less common in the statin-treated group. Severity of vasospasm, as assessed on the most severe angiogram, was lowered with statin. Statins significantly reduced volume of ischemia in patients with vasospasm and an uncomplicated coiling procedure. S100B levels were significantly lower in statin-treated patients, and the decrease was greatest among high-grade patients (World Federation of Neurological Surgeons 3–5). No differences were found between statin-treated and untreated groups regarding rescue therapy intensity or 1-yr clinical outcomes.
CONCLUSIONS:Atorvastatin reduces the incidence, the severity and the ischemic consequences of vasospasm as assessed on computed tomography. In high-grade World Federation of Neurological Surgeons patients, atorvastatin decreases serum levels of S100B, a biomarker of brain ischemia. Despite these positive effects on biomarkers, no improvement of outcome was seen in the overall population, although there was a tendency for a better clinical outcome in high-grade patients.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>21926584</pmid><doi>10.1097/CCM.0b013e31822f05e7</doi><tpages>9</tpages></addata></record> |
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| ispartof | Critical care medicine, 2012-02, Vol.40 (2), p.594-602 |
| issn | 0090-3493 1530-0293 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Atorvastatin Calcium Biological and medical sciences Biomarkers - blood Brain Ischemia - diagnosis Brain Ischemia - drug therapy Brain Ischemia - etiology Case-Control Studies Confidence Intervals Critical Care - methods Critical Illness - mortality Critical Illness - therapy Female Follow-Up Studies Glasgow Coma Scale Heptanoic Acids - administration & dosage Hospitals, University Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage Intensive care medicine Intensive Care Units Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Nerve Growth Factors - blood Predictive Value of Tests Pyrroles - administration & dosage Radiodiagnosis. Nmr imagery. Nmr spectrometry Respiratory system Retrospective Studies Risk Assessment S100 Calcium Binding Protein beta Subunit S100 Proteins - blood Severity of Illness Index Statistics, Nonparametric Subarachnoid Hemorrhage - complications Subarachnoid Hemorrhage - diagnosis Survival Rate Tomography, X-Ray Computed - methods Treatment Outcome Vasospasm, Intracranial - drug therapy Vasospasm, Intracranial - prevention & control |
| title | Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: A comparative study |
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