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Updated: Sep 24, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Delayed cerebral ischemia: A look at the role of endothelial dysfunction, emerging endovascular management, and
Kartik Motwani1, William S Dodd1, Dimitri Laurent1
1Department of Neurosurgery, University of Florida, Gainesville, USA.
Insights
Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) causes significant patient harm. This review explores DCI pathophysiology, including the glymphatic system, and current treatments, aiming to bridge the gap toward targeted therapies.
Area of Science:
- Neuroscience
- Neurology
- Critical Care Medicine
Background:
- Delayed cerebral ischemia (DCI) is a major cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH).
- Cerebral vasospasm (CV) is linked to DCI, but DCI can also impact brain areas distant from vasospasm.
- Emerging research offers new insights into DCI's underlying mechanisms.
Purpose of the Study:
- To review recent advancements in understanding DCI pathophysiology.
- To discuss current and potential therapeutic strategies for DCI.
- To identify research gaps and catalyze future discoveries for improved DCI treatment.
Main Methods:
- Review of current literature on DCI pathophysiology and treatment.
- Analysis of emerging concepts, including the role of the glymphatic system.
- Discussion of pharmacologic and endovascular treatment options for vasospasm.
Main Results:
- DCI pathophysiology involves more than just cerebral vasospasm, with implications for remote brain parenchyma.
- The glymphatic system is an emerging area of interest in DCI research.
- A significant gap exists between current interventions and pathophysiology-targeted treatments.
Conclusions:
- Further research is needed to understand the complex pathophysiology of DCI.
- Developing treatments that target specific DCI mechanisms is crucial for improving patient outcomes.
- This review aims to stimulate research for novel therapeutic approaches to DCI.
Abstract:
Delayed cerebral ischemia (DCI) contributes to extensive morbidity and mortality for patients with aneurysmal subarachnoid hemorrhage (SAH). Recent contributions to the basic and translational investigation of DCI have shed light on emerging concepts that may aid in the development of novel therapeutics. A clear association between cerebral vasospasm (CV) and DCI exists, but it is also known that DCI can affect brain parenchyma remote from sites of vasospasm. In this review, we highlight the most recent contributions to the understanding of the underlying pathophysiology of DCI including the emerging role of the glymphatic system. Furthermore, we discuss treatments for DCI, including both pharmacologic therapies and endovascular treatment of vasospasm. There continues to be a disconnect between interventions and targeted treatment against pathophysiology. This review is intended to serve as a catalyst for further research and discovery that can aid in improved treatment options for DCI.
