Abstract
BackgroundCerebral vasospasm (CVS) is a common serious complication after the spontaneous subarachnoid hemorrhage (SAH). Despite recent advances in medical and surgical treatments, the 30-day mortality rate of SAH remains high, and there is lack of especially effective clinical treatment to alleviate and improve CVS. The present study has investigated the therapeutic effect of insulin and vitamin C on CVS after SAH.ResultsFive days after SAH, there is obvious basilar artery spasm in SAH group, whose average vascular cross-sectional area (233,099 ± 16,750 μm2) is significantly smaller than that in control group (462,128 ± 74,756 μm2), which is also significantly different from those in SAH + insulin group (221,114 ± 43,457 μm2) and SAH + vitamin C group (237,820 ± 21,703 μm2). SAH + insulin + vitamin C group shows no evident vasospasm and maintains a vascular cross-sectional area of 425,530 ± 45,503 μm2, which is significantly different from that in SAH group. Insulin receptor α (InRα) expression is significantly downregulated in the vascular endothelial cells of SAH, SAH + insulin, and SAH + vitamin C groups (P < 0.01) but remains unchanged in vascular endothelial cells of SAH + insulin + vitamin C group (P > 0.05). Five days after SAH, serum and cerebrospinal fluid NO levels in SAH, SAH + insulin, and SAH + vitamin C groups decrease significantly (P < 0.01) compared to that in control group, whereas the reduction is not evident in SAH + insulin + vitamin C group (P > 0.05).ConclusionCombinatorial treatment with insulin and vitamin C has effectively relieved the CVS after SAH in rabbit, possibly through increasing the InRα expression and NO level, whereas treatment with insulin or vitamin C alone fails to do so.
Highlights
Cerebral vasospasm (CVS) is a common serious complication after the spontaneous subarachnoid hemorrhage (SAH)
In this study, combinatorial use of insulin and vitamin C has successfully alleviated the CVS after SAH, though individual administration of either insulin or vitamin C fails to achieve the desired effects, which confirms the destructive effect of oxygen free radicals on vascular endothelial cells and the significant vasodilatory effect of insulin
Previous studies have confirmed that inhibition of insulin’s vasoactive effect induces insulin resistance and hyperinsulinemia, which is the major cause of atherosclerosis and coronary artery spasm [5,6,7]
Summary
Cerebral vasospasm (CVS) is a common serious complication after the spontaneous subarachnoid hemorrhage (SAH). Despite recent advances in medical and surgical treatments, the 30-day mortality rate of SAH remains high, and there is lack of especially effective clinical treatment to alleviate and improve CVS. The present study has investigated the therapeutic effect of insulin and vitamin C on CVS after SAH. CVS is a common serious complication after the spontaneous SAH It induces and aggravates cerebral ischemic injury and becomes one of the major causes of disability and mortality after aneurysm rupture. The cross-sectional area of basilar artery The vascular cross-sectional area in SAH + insulin + vitamin C group is 425,529.9 ± 45,502.98 μm, which shows no significant difference from that in control group (462,127.9 ± 74,755.82 μm, P = 0.605). There is significant difference between SAH + insulin + vitamin C group and SAH group (P < 0.01, Table 1)
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