Endothelial and Glycocalyx Proteins as Biomarkers in Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage

Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) remains a relevant issue in the critical care management of patients following aneurysm repair. It is thought to contribute to poor neurologic outcome in up to 30% of patients following SAH [1] and vigilance for delayed neurologic deterioration in the ICU remains high to prevent prolonged periods of unattended ischemic injury. Historically, the pathogenesis of DCI has been attributed primarily to angiographic vasospasm of the arteries of the circle of Willis [1]. The treatment of DCI indeed focuses on mitigating vasospastic events; namely, prophylactic nimodipine, intraarterial milrinone, balloon angioplasty, blood pressure augmentation and neurointensive care.