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Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study

OBJECTIVE: Cerebral vasospasm is the commonest cause for mortality and morbidity in patients following clipping of a ruptured aneurysm. Selective phosphodiesterase (PDE) inhibitor like sildenafil acts as a vasodilator. The objective of this study was to evaluate the safety and feasibility of oral si...

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Autores principales: Mukherjee, Kanchan K., Singh, Shrawan K., Khosla, Virender K., Mohindra, Sandeep, Salunke, Pravin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280003/
https://www.ncbi.nlm.nih.gov/pubmed/22347673
http://dx.doi.org/10.4103/2152-7806.92164
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author Mukherjee, Kanchan K.
Singh, Shrawan K.
Khosla, Virender K.
Mohindra, Sandeep
Salunke, Pravin
author_facet Mukherjee, Kanchan K.
Singh, Shrawan K.
Khosla, Virender K.
Mohindra, Sandeep
Salunke, Pravin
author_sort Mukherjee, Kanchan K.
collection PubMed
description OBJECTIVE: Cerebral vasospasm is the commonest cause for mortality and morbidity in patients following clipping of a ruptured aneurysm. Selective phosphodiesterase (PDE) inhibitor like sildenafil acts as a vasodilator. The objective of this study was to evaluate the safety and feasibility of oral sildenafil citrate in patients with symptomatic refractory vasospasm. METHODS: A total of 832 patients with aneurysmal subarachnoid bleed were operated in 4 years. Two hundred and seventy-three patients had vasospasm. Of these, 72 patients had refractory cerebral vasospasm. Vasospasm was defined as refractory when institution of “HHH” failed to reverse the transcranial Doppler (TCD) values even after 24 hours. Computed tomography (CT) scan showed no infarct, hematoma, or hydrocephalus, and the serum electrolytes were within normal limits. They received 100–150 mg of sildenafil every 4 hours. Response was evaluated by 2-hourly TCD. RESULTS: Eight patients had sustained (TCD values normal for >48 hours) and four had temporary relief in vasospasm, as suggested. Four patients developed complications significant enough to terminate the therapy. CONCLUSIONS: Sildenafil citrate may be effective in patients with refractory symptomatic vasospasm. It calls upon the pharmacologists and scientists to discover newer supraselective PDE inhibitors, specific to PDE receptors in brain vessels.
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spelling pubmed-32800032012-02-16 Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study Mukherjee, Kanchan K. Singh, Shrawan K. Khosla, Virender K. Mohindra, Sandeep Salunke, Pravin Surg Neurol Int Original Article OBJECTIVE: Cerebral vasospasm is the commonest cause for mortality and morbidity in patients following clipping of a ruptured aneurysm. Selective phosphodiesterase (PDE) inhibitor like sildenafil acts as a vasodilator. The objective of this study was to evaluate the safety and feasibility of oral sildenafil citrate in patients with symptomatic refractory vasospasm. METHODS: A total of 832 patients with aneurysmal subarachnoid bleed were operated in 4 years. Two hundred and seventy-three patients had vasospasm. Of these, 72 patients had refractory cerebral vasospasm. Vasospasm was defined as refractory when institution of “HHH” failed to reverse the transcranial Doppler (TCD) values even after 24 hours. Computed tomography (CT) scan showed no infarct, hematoma, or hydrocephalus, and the serum electrolytes were within normal limits. They received 100–150 mg of sildenafil every 4 hours. Response was evaluated by 2-hourly TCD. RESULTS: Eight patients had sustained (TCD values normal for >48 hours) and four had temporary relief in vasospasm, as suggested. Four patients developed complications significant enough to terminate the therapy. CONCLUSIONS: Sildenafil citrate may be effective in patients with refractory symptomatic vasospasm. It calls upon the pharmacologists and scientists to discover newer supraselective PDE inhibitors, specific to PDE receptors in brain vessels. Medknow Publications & Media Pvt Ltd 2012-01-21 /pmc/articles/PMC3280003/ /pubmed/22347673 http://dx.doi.org/10.4103/2152-7806.92164 Text en Copyright: © 2012 Mukherjee KK. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Original Article
Mukherjee, Kanchan K.
Singh, Shrawan K.
Khosla, Virender K.
Mohindra, Sandeep
Salunke, Pravin
Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study
title Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study
title_full Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study
title_fullStr Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study
title_full_unstemmed Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study
title_short Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study
title_sort safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: a feasibility study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280003/
https://www.ncbi.nlm.nih.gov/pubmed/22347673
http://dx.doi.org/10.4103/2152-7806.92164
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