Soluble Fms-Like Tyrosine Kinase 1 (sFlt-1) and Risk of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage.

Abstract

BACKGROUND:

The molecular mechanisms underlying cerebral vasospasm and delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) are incompletely understood. We hypothesized that circulating antiangiogenic factors, such as soluble Fms-like tyrosine kinase 1 (sFlt-1) and soluble transforming growth factor β coreceptor, soluble endoglin (sEng), are important markers of their pathophysiology.

METHODS:

We performed a prospective study in patients with aSAH and measured cerebrospinal fluid and serum levels of sFlt-1 and sEng on postbleed day 1 and 6 and correlated levels with incidence and severity of cerebral vasospasm and DCI.

RESULTS:

Twenty-seven patients with aSAH were enrolled in the study. Severe angiographic vasospasm was present in 14.8% of patients and DCI occurred in 33.3%. Serum sFlt1 levels were increased on postbleed day 6 in patients who developed vasospasm. However, on postbleed day 1, there were no differences in patients who developed vasospasm. Increased serum sFlt-1 levels on postbleed day 1 were found to predict the development of severe angiographic vasospasm with an area under the curve of 0.818 with an optimal cutoff value of 95 pg/mL. Alterations in sFlt1 were not associated with DCI. Serum and cerebrospinal fluid sEng levels did not correlate with vasospasm or DCI.

CONCLUSIONS:

Serum levels of sFlt-1 are increased in patients with aSAH who are at risk for severe vasospasm. Further studies with larger sample sizes are needed to evaluate whether sFlt-1 levels may predict onset of severe vasospasm and DCI.

• Authors: Christoph J Griessenauer, Michelle H Chua, Khalid A Hanafy, Yaw Tachie Baffour, Ruiya Chen, Robert H LeBlanc 3rd, Apar S Patel, Mohamed Salem, S Ananth Karumanchi, Dihua Xu, Ravi Thadhani, Christopher S Ogilvy, Ajith J Thomas
• Journal: World neurosurgery (World Neurosurg) Vol. 108 Pg. 84-89 (Dec 2017) ISSN: 1878-8769 [Electronic] United States
• PMID: 28867315 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• ENG protein, human
• Endoglin
• FLT1 protein, human
• Vascular Endothelial Growth Factor Receptor-1

Topics

• Adult
• Aged
• Aged, 80 and over
• Biomarkers (blood, cerebrospinal fluid)
• Brain (diagnostic imaging)
• Cerebral Angiography
• Endoglin (metabolism)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Prospective Studies
• Risk Factors
• Sensitivity and Specificity
• Severity of Illness Index
• Subarachnoid Hemorrhage (complications, epidemiology, metabolism, therapy)
• Treatment Outcome
• Vascular Endothelial Growth Factor Receptor-1 (metabolism)
• Vasospasm, Intracranial (epidemiology, etiology, metabolism, therapy)
• Young Adult