Experimental cerebral vasospasm. Part 2. Contractility of spastic arterial wall

Perivascular neurotransmitters: Regulation of cerebral blood flow and role in primary headaches

In order to understand the nature of the relationship between cerebral blood flow (CBF) and primary headaches, we have conducted a literature review with particular emphasis on the role of perivascular neurotransmitters. Primary headaches are in general considered complex polygenic disorders (genetic and environmental influence) with pathophysiological neurovascular alterations. Identified candidate headache genes are associated with neuro- and gliogenesis, vascular development and diseases, and regulation of vascular tone. These findings support a role for the vasculature in primary headache disorders. Moreover, neuronal hyperexcitability and other abnormalities have been observed in primary headaches and related to changes in hemodynamic factors. In particular, this relates to migraine aura and spreading depression. During headache attacks, ganglia such as trigeminal and sphenopalatine (located outside the blood-brain barrier) are variably activated and sensitized which gives rise to vasoactive neurotransmitter release. Sympathetic, parasympathetic and sensory nerves to the cerebral vasculature are activated. During migraine attacks, altered CBF has been observed in brain regions such as the somatosensory cortex, brainstem and thalamus. In regulation of CBF, the individual roles of neurotransmitters are partly known, but much needs to be unraveled with respect to headache disorders.

Thermomechanical properties, collapse pressure, and expansion of shape memory polymer neurovascular stent prototypes

Shape memory polymer stent prototypes were fabricated from thermoplastic polyurethane. Commercial stents are generally made of stainless steel or other alloys. These alloys are too stiff and prevent most stent designs from being able to navigate small and tortuous vessels to reach intracranial lesions. A solid tubular model and a high flexibility laser etched model are presented. The stents were tested for collapse in a pressure chamber. At 37 degrees C, the full collapse pressure was comparable to that of commercially available stents, and higher than the estimated maximum pressure exerted by intracranial arteries. However, there is a potential for onset of collapse, which needs further study. The stents were crimped and expanded, the laser-etched stent showed full recovery with an expansion ratio of 2.7 and a 1% axial shortening.

Biochemomechanics of cerebral vasospasm and its resolution: I. A new hypothesis and theoretical framework

The etiology, and hence most effective treatment, of cerebral vasospasm remains unknown, thus this devastating sequela to subarachnoid hemorrhage continues to be responsible for significant morbidity and mortality. Based on abundant and diverse clinical and laboratory observations, we hypothesize that vasospasm and its subsequent resolution result from a short-term chemo-dominated turnover of cells and matrix in evolving vasoconstricted states that produces a narrowed lumen and thicker wall, which is stiffer and largely unresponsive to exogenous vasodilators, and a subsequent mechano-dominated turnover of cells and matrix in evolving vasodilated states that restores the vessel toward normal. There is, however, a pressing need for a mathematical model of arterial growth and remodeling that can guide the design and interpretation of experiments to test this and competing hypotheses. Toward this end, we present a new biochemomechanical framework that couples a 2-D model of the evolving geometry, structure, and properties of the affected arterial wall, a 1-D model of the blood flow within the affected segment, and a 0-D model of the biochemical insult to the segment. We submit that such a framework can capture salient features of the time-course of vasospasm and its potential resolution, as illustrated numerically in part II of this paper.

Contribution of the remodeling response to cerebral vasospasm

The authors review the remodeling response of blood vessels that occurs after various injuries to arteries. The role of this response in vasospasm after subarachnoid hemorrhage (SAH) is reviewed. There is some evidence that cerebral arteries remodel after SAH in that they are less compliant and contractile than normal. Evidence for other features, such as alteration of smooth muscle phenotype, proliferation of cells and synthesis of extracellular matrix, is conflicting and requires a further study. A remodeling response probably contributes to vasospasm but the magnitude of its importance, in relation to smooth muscle contraction, which also occurs, also needs to be further defined.

Calcium sensitivity of vasospastic basilar artery after experimental subarachnoid hemorrhage

Arteries that develop vasospasm after subarachnoid hemorrhage (SAH) may have altered contractility and compliance. Whether these changes are due to alterations in the smooth muscle cells or the arterial wall extracellular matrix is unknown. This study elucidated the location of such changes and determined the calcium sensitivity of vasospastic arteries. Dogs were placed under general anesthesia and underwent creation of SAH using the double-hemorrhage model. Vasospasm was assessed by angiography performed before and 4, 7, or 21 days after SAH. Basilar arteries were excised from SAH or control dogs ( n = 8–52 arterial rings from 2–9 dogs per measurement) and studied under isometric tension in vitro before and after permeabilization of smooth muscle with α-toxin. Endothelium was removed from all arteries. Vasospastic arteries demonstrated significantly reduced contractility to KCl with a shift in the EC50toward reduced sensitivity to KCl 4 and 7 days after SAH ( P < 0.05, ANOVA). There was reduced compliance that persisted after permeabilization ( P < 0.05, ANOVA). Calcium sensitivity was decreased during vasospasm 4 and 7 days after SAH, as assessed in permeabilized arteries and in those contracted with BAY K 8644 in the presence of different concentrations of extracellular calcium ( P < 0.05, ANOVA). Depolymerization of actin with cytochalasin D abolished contractions to KCl but failed to alter arterial compliance. In conclusion, it is shown for the first time that calcium sensitivity is decreased during vasospasm after SAH in dogs, suggesting that other mechanisms are involved in maintaining the contraction. Reduced compliance seems to be due to an alteration in the arterial wall extracellullar matrix rather than the smooth muscle cells themselves because it cannot be alleviated by depolymerization of smooth muscle actin.