Nitric oxide inhalation reduces brain damage, prevents mortality, and improves neurological outcome after subarachnoid hemorrhage by resolving early pial …

NA Terpolilli, S Feiler, A Dienel… - Journal of Cerebral …, 2016 - journals.sagepub.com
NA Terpolilli, S Feiler, A Dienel, F Müller, N Heumos, B Friedrich, J Stover, S Thal, K Schöller…
Journal of Cerebral Blood Flow & Metabolism, 2016journals.sagepub.com
Subarachnoid hemorrhage is a stroke subtype with particularly bad outcome. Recent
findings suggest that constrictions of pial arterioles occurring early after hemorrhage may be
responsible for cerebral ischemia and–subsequently–unfavorable outcome after
subarachnoid hemorrhage. Since we recently hypothesized that the lack of nitric oxide may
cause post-hemorrhagic microvasospasms, our aim was to investigate whether inhaled nitric
oxide, a treatment paradigm selectively delivering nitric oxide to ischemic microvessels, is …
Subarachnoid hemorrhage is a stroke subtype with particularly bad outcome. Recent findings suggest that constrictions of pial arterioles occurring early after hemorrhage may be responsible for cerebral ischemia and – subsequently – unfavorable outcome after subarachnoid hemorrhage. Since we recently hypothesized that the lack of nitric oxide may cause post-hemorrhagic microvasospasms, our aim was to investigate whether inhaled nitric oxide, a treatment paradigm selectively delivering nitric oxide to ischemic microvessels, is able to dilate post-hemorrhagic microvasospasms; thereby improving outcome after experimental subarachnoid hemorrhage. C57BL/6 mice were subjected to experimental SAH. Three hours after subarachnoid hemorrhage pial artery spasms were quantified by intravital microscopy, then mice received inhaled nitric oxide or vehicle. For induction of large artery spasms mice received an intracisternal injection of autologous blood. Inhaled nitric oxide significantly reduced number and severity of subarachnoid hemorrhage-induced post-hemorrhage microvasospasms while only having limited effect on large artery spasms. This resulted in less brain-edema-formation, less hippocampal neuronal loss, lack of mortality, and significantly improved neurological outcome after subarachnoid hemorrhage. This suggests that spasms of pial arterioles play a major role for the outcome after subarachnoid hemorrhage and that lack of nitric oxide is an important mechanism of post-hemorrhagic microvascular dysfunction. Reversing microvascular dysfunction by inhaled nitric oxide might be a promising treatment strategy for subarachnoid hemorrhage.
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