Endothelial cell activation seems to be an important process in the multifactorial pathophysiology of delayed cerebral ischemia (DCI) and subsequent poor clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH).

To assess the association between biomarker levels of endothelial activation and the occurrence of DCI and poor clinical outcome six months after aSAH.

Between October 2018 and November 2020, 75 aSAH patients were included. Blood samples were taken on admission, days 3–5 and days 9–11 after aSAH. Ten patients with unruptured intracranial aneurysms served as controls. Poor outcome was assessed at six months, defined by a modified Rankin Scale score of 4–6. The cohort was dichotomized into patients with and without DCI and good and poor outcomes. Biomarker levels of von Willebrand factor (vWF), E-selectin, thrombomodulin, syndecan-1 and matrix metalloproteinase (MMP-9) were analyzed and compared between groups by a T-test or Mann–Whitney U test, depending on the normality of the data.

Twelve (16.0%) patients developed DCI, and 39 (41.9%) patients had poor outcomes at six months post-aSAH. None of the biomarkers showed significant differences between patients with and without DCI. vWF and syndecan-1 were elevated on admission and on days 9–11 in patients with poor outcomes (p < 0.05 and p = 0.02, respectively).

Levels of vWF, E-selectin, thrombomodulin, syndecan-1 and MMP-9 were not associated with the occurrence of DCI, although higher levels of vWF and syndecan-1 were associated with poor outcome at six months. Further research is needed to establish the role of these biomarkers in aSAH patients.

Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. There is little high-quality evidence available to guide the management of DCI. The Canadian Neurosurgery Research Collaborative (CNRC) is comprised of resident physicians who are positioned to capture national, multi-site data. The objective of this study was to evaluate practice patterns of Canadian physicians regarding the management of aSAH and DCI.

We performed a cross-sectional survey of Canadian neurosurgeons, intensivists, and neurologists who manage aSAH. A 19-question electronic survey (Survey Monkey) was developed and validated by the CNRC following a DCI-related literature review (PubMed, Embase). The survey was distributed to members of the Canadian Neurosurgical Society and to Canadian members of the Neurocritical Care Society. Responses were analyzed using quantitative and qualitative methods.

The response rate was 129/340 (38%). Agreement among respondents was limited to the need for intensive care unit admission, use of clinical and radiographic monitoring, and prophylaxis for the prevention of DCI. Several inconsistencies were identified. Indications for starting hyperdynamic therapy varied. There was discrepancy in the proportion of patients who felt to require IV milrinone, IA vasodilators, or physical angioplasty for treatment of DCI. Most respondents reported their facility does not utilize a standardized definition for DCI.

DCI is an important clinical entity for which no homogeneity and standardization exists in management among Canadian practitioners. The CNRC calls for the development of national standards in the definition, identification, and treatment of DCI.