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Cervical sympathectomy to treat cerebral vasospasm: a scoping review.

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Date
2022-11
Authors
Bombardieri, Anna Maria
Heifets, Boris D
Treggiari, Miriam
Albers, Gregory W
Steinberg, Gary K
Heit, Jeremy J
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Abstract
<h4>Background/importance</h4>Delayed cerebral ischemia (DCI) is the second-leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (aSAH), and is associated with cerebral arterial vasospasm (CAV). Current treatments for CAV are expensive, invasive, and have limited efficacy. Cervical sympathetic block (CSB) is an underappreciated, but potentially highly effective therapy for CAV.<h4>Objective</h4>To provide a comprehensive review of the preclinical and human literature pertinent to CSB in the context of CAV.<h4>Evidence review</h4>This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a literature search using Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science until February 2022, to identify abstracts, conference proceedings, and full-text papers pertinent to cervical sympathectomy and CAV in animal/adult patients.<h4>Findings</h4>We included six human and six experimental studies. Human studies were mostly prospective observational, except one retrospective and one randomized clinical trial, and used various imaging modalities to measure changes in arterial diameter after the block. Studies that used digital subtraction angiography showed an improvement in cerebral perfusion without change in vessel diameter. Transcranial Doppler studies found an approximately 15% statistically significant decrease in velocities consistent with arterial vasodilatation. Overall, the results suggest an increase in cerebral arterial diameter and neurological improvement in patients receiving a CSB. Animal studies demonstrate that sympathetic system ablation vasodilates cerebral vasculature and decreases the incidence of symptomatic vasospasm.<h4>Conclusions</h4>This scoping review suggests that CSB may be a viable option for treatment and prevention of CAV/DCI in patients with aSAH, although the included studies were heterogeneous, mostly observational, and with a small sample size. Further research is needed to standardize the technique and prove its effectiveness to treat patients suffering of CAV/DCI after aSAH.
Type
Journal article
Subject
critical care
nerve block
neurologic manifestations
outcome assessment, health care
Permalink
https://hdl.handle.net/10161/26270
Published Version (Please cite this version)
10.1136/rapm-2022-103999
Publication Info
Bombardieri, Anna Maria; Heifets, Boris D; Treggiari, Miriam; Albers, Gregory W; Steinberg, Gary K; & Heit, Jeremy J (2022). Cervical sympathectomy to treat cerebral vasospasm: a scoping review. Regional anesthesia and pain medicine. pp. rapm-2022-103999. 10.1136/rapm-2022-103999. Retrieved from https://hdl.handle.net/10161/26270.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Treggiari

Miriam Treggiari

Instructor Temporary in the Department of Anesthesiology
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