Article Data

  • Views 537
  • Dowloads 134

Original Research

Open Access

Testing of potential biomarkers of cerebral ischemia and vasospasm in patients with cerebral aneurysm surgery


1Department of Anesthesiology, Reanimatology and Intensive Care of Neurosurgical Patients Anesthesiology, Reanimatology and Intensive Care University Hospital Centre Zagreb

DOI: 10.22514/SV102.122015.6 Vol.10,Issue 2,December 2015 pp.89-108

Published: 14 December 2015

*Corresponding Author(s): JELENA RADONIC E-mail:


Biomarkers for the prediction of vasospasm and delayed cerebral ischemia in patients with a ruptured cerebral aneurysm could be helpful.

In this prospective clinical study, endothelin-1, lactate, pCO2, and pO2 were measured in arterial and internal jugular vein blood before, during and after surgical treatment of a cerebral aneurysm, and were tested as potential predictors of neurologic outcome in patients.

Forty-one patients were enrolled in the study, 23 of them were operated on after aneurismal rupture with development of subarachnoid hemorrhage (SAH) and 18 patients were operated on for a nonruptured aneurysm.

All of the involved patients survived. There was no difference in neurologic outcome between those operated on with a ruptured or nonruptured aneurysm.

Endothelin-1 and lactate concentrations as well as pO2 and pCO2 from arterial and venous blood samples and their venoarterial difference did not differ between groups with and without an aneurismal rupture. Venoarterial difference of endothelin-1 concentrations on the day after surgery significantly differed between the groups with favorable and nonfavorable neurologic outcome. Other variables did not show a statistically significant difference.

Significant correlation was found between endothelin-1 and lactate concentrations, suggesting involvement of the same pathophysiological process.

Another interesting finding was lower arterial and venous pCO2 in patients with lower initial Glasgow Coma Scale (GCS) score and higher Hunt Hess score in the phase after extubation.

We can conclude that the measured biochemical parameters did not show sufficient predictive power to be useful for prediction of cerebral vasospasm and neurologic outcome in everyday clinical practice. However, some correlations that do exist between them suggest involvement of the same pathophysiological process.


cerebral aneurysm, neurosurgery, endothelin-1, biomarkers, delayed cerebral ischemia

Cite and Share

JELENA RADONIC,DUNJA ROGIC,RADOVAN RADONIC,TAMARA MURSELOVIC,VASILIJE STAMBOLIJA,JADRANKA KATANCIC,MARIN LOZIC,LJILJANA POPOVIC. Testing of potential biomarkers of cerebral ischemia and vasospasm in patients with cerebral aneurysm surgery. Signa Vitae. 2015. 10(2);89-108.


36. Teasdale G, Jennett B. Assesment of coma and impaired consciousness. Lancet 1974;2:81-4.

37. Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 1976;34:45-55.

38. Vergouwen MDI, Vermeulen M, Gijn JV, Rinkel GJE, Wijdicks EF, Muizelaar JP, et al. Definition of delayed cerebral ischemia after aneurismal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies.Stroke 2010;41:2391–5.

39. Toffaletti JG. Blood lactate: biochemistry, laboratory methods, and clinical interpretation. Crit Rev Clin Lab Sci 1991;28:253-68.

40. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet


41. Rankin L. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200 –15.

42. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van GJ. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–7.

43. Banks JL , Marotta CA . Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 2007 Mar;38(3):1091-6.

44. Kozniewska E, Michalik R, Rafalowska J, Gadamski R, Walski M, Frontczak-Baniewicz M, et al. Mechanisms of vascular dysfunction after subarachnoid hemorrhage. J Physiol Pharmacol 2006;57(Suppl 11):145–60.

45. Stein SC, Levine JM, Nagpal S, LeRoux PD. (2006) Vasospasm as the sole cause of cerebral ischemia: how strong is the evidence? Neurosurg Focus 2006;21:E2.

46. Weidauer S, Vatter H, Beck J, Raabe A, Lanfermann H, Seifert V, Zanella F. Focal laminar cortical infarcts following aneurismal subarachnoid haemorrhage. Neuroradiology 2008;50:1–8.

47. Ng WH, Moochhala S, Yeo TT, Ong PL, Ng PY. Nitric oxide and subarachnoid hemorrhage: elevated level in cerebrospinal fluid and their implications. Neurosurgery 2001;49:622-7.

48. Romano JG, Rabinstein AA, Arheart KL, Nathan S, Campo-Bustillo I, Koch S, et al. Microemboli in aneurismal subarachnoid hemorrhage. J Neuroimaging 2008;18:396–401.

49. Juvela S. Plasma endothelin concentrations after aneurysmal subarachnoid haemorrhage. J Neurosurg 2000;92:390-400.

50. Menon DK, Day D, Kuc RE, Downie AJ, Chatfield DA, Davenport AP. Arteriojugular endothelin-1 gradients in aneurysmal subarachnoid haemorrhage. Clin Sci (Lond) 2002;suppl48:399S.

51. Siman R , Giovannone N , Toraskar N , Frangos S , Stein SC , Levine JM, et al. Evidence that a panel of neurodegeneration biomarkers predicts vasospasm, infarction, and outcome in aneurismal subarachnoid hemorrhage. PLoS One 2011;6:12.

52. Mascia L, Fedorko L, Stewart DJ, Mohamed F, terBrugge K, RanieriVM, et al. Temporal relationship between endothelin-1 concentrations and cerebral vasospasm in patients with aneurismal subarachnoid hem- orrhage. Stroke 2001;32:1185–90.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time