Degradation of the Glycocalyx in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
Degradation of the Glycocalyx in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
This study will provide novel information to the literature base for the pathophysiology of
 aneurysmal subarachnoid hemorrhage. The association of breakdown products in the serum of
 aSAH patients were reported in a very small case series of 3 patients, as mentioned above.
 However, while their results are intriguing and encouraging, our study will provide more
 definitive information about the GC in aSAH. If there is a positive correlation, the results
 of this study will guide future investigations into new therapies for this devastating
 disease such as MMP inhibition with doxycycline.
1. The study will aim to recruit all eligible patients at UTMCK and the University of
 Virginia hospital over a 12 month period. Our main outcome measure is degradation of the
 glycocalyx in patients with aSAH. All eligible patients with confirmed aSAH admitted to
 the neuro-intensive care unit will be enrolled after consent is obtained from the family
 and/or the patient. Serum samples will be drawn from each patient on admission (day 1)
 and every other day until day 13 for a total of 7 samples per patient.

 The following serum tests will be performed:

 2. Measurement of serum syndecan-1 by ELISA

 3. Measurement of serum heparan-sulfate by ELISA

 4. Measurement of serum matrix metalloproteinases -9

 5. Measurement of serum matrix-metalloproteinase-1

 6. Measurement of urinary microalbumin-to-creatinine ratio

 7. Measurement of daily TCDs (all patients currently receive daily TCDs as part of the aSAH
 protocol at UTMCK and UVA Hospital)

 8. Outcomes:

 a) Chart review: i) Incidence of DCI as defined by a consensus committee on this subject
 and published in the journal Stroke [29].

 ii) In-hospital mortality will be recorded b) Follow-up performed by phone call or
 searching the Social Security Death Index [30]: i) 30-day mortality ii) 90-day mortality
 c) Outcomes follow-up: i) The Glasgow Outcome Scale 12 weeks post aSAH [31]
Inclusion Criteria:

 -  • Age 18 years of age and older

 -  Cerebral aneurysm on CT-angio

 Exclusion Criteria:

 -  • comfort care only orders,

 -  the absence of an aneurysm on CT-angiography,

 -  onset of aneurysm rupture > 24 hours,

 -  and inability to obtain informed consent from patient or family pregnant women