Editor—In 1936, Leriche and Fontaine first drew attention to the fact that stellate ganglion block (SGB) caused a ‘striking regression of symptoms in two cases of postoperative hemiplegia’.1 Since then, numerous studies have emphasized the usefulness of SGB to reduce the vascular spasm associated with cerebral thrombosis and embolism.1 Stellate ganglion block causes sympathetic inhibition of the ispilateral head, neck, upper thorax, and arms, resulting in peripheral vasodilation.2 However, its effects on cerebral haemodynamics, in ageing, or in subarachnoid haemorrhage (SAH) are not clear. This study demonstrates, for the first time, the importance of SGB to clarify age-related or SAH-related differences in vasospasm and the efficacy of SGB in relation to the responses of basilar arteries.
Age is a major risk factor for a poor outcome in patients with cerebral vascular disease, including SAH.3,4 Recent studies have shown that the incidence of SAH in the elderly, especially those older than 60 yr of age, is increasing with the increased age of the general population.3,4 In the aged brain, there is a reduction in the angiogenesis response because of decreased responsiveness to hypoxia-inducible factor 1.5,6 Although the biological and medical consequences of a stroke are significant at any age, the incidence and severity of a stroke is significantly increased with age. Gupta and colleagues7 and Jain and colleagues8 found that SGB decreases cerebral vascular tone without affecting the capacity of cerebral blood vessels to react to the changes in carbon dioxide or to autoregulate. Stellate ganglion block might have a therapeutic role in patients where cerebral insufficiency can be attributed to cerebral vasospasm.
Fig 1.
Representative sagittal views showing measurement of the calibre of the middle cerebral artery (MCA), vertebral artery (VA), and arteriae basilaris (BA) in an elderly patient and in a patient with subarachnoid haemorrhage on digital subtraction angiography. (a–d) A male patient aged 75 yr suffered from an intracranial aneurysm. After stellate ganglion block (SGB), the calibre of the MCA increased from 3.386 (a) to 3.804 mm (b), the calibre of the VA increased from 3.328 (c) to 3.855 mm (d), and the calibre of the BA increased from 2.891 (c) to 3.121 mm (d). (e–h) A male patient aged 56 yr suffered from an aneurysm of arteriae cerebri media M2 temporal region with subarachnoid haemorrhage. After SGB, the calibre of the MCA increased from 2.589 (e) to 2.809 mm (f), the calibre of the VA increased from 3.476 (g) to 3.921 mm (h), and the calibre of the BA increased from 2.612 (g) to 3.161 mm (h).
In the present study, after SGB a significant increase in the calibre of middle cerebral artery (MCA), vertebral artery (VA), and arteriae basilaris (BA) in adult patients and elderly patients was observed (Fig. 1). The increase in calibre of the MCA, VA, and BA in adult patients was higher than that in elderly patients. We also found that the calibre of the MCA, VA, and BA was increased in patients with or without SAH after treatment with SGB (Fig. 1). Interestingly, the increase in blood vessel calibre was larger in patients with SAH compared with patients without SAH. Importantly, SGB did not induce bleeding but reduced cerebral vasospasm.
Taken together, these studies suggest the possibility that SGB might have potential use in the treatment or control of cerebral vascular accidents in both elderly patients and patients with SAH and might promisingly be applied clinically after further research. Further studies are needed to determine cerebral vascular changes through prolonged observation or by repeating the block in elderly patients and patients with SAH.
Declaration of interest
None declared.
Funding
National Science Foundation of China (81301664, 30971202); Natural Science Foundation of Guangdong Province (S2013010014312, 2015A030313297).
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