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The Role of Sartans in the Treatment of Stroke and Subarachnoid Hemorrhage: A Narrative Review of Preclinical and Clinical Studies

1
Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland
2
Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3008 Bern, Switzerland
3
Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
*
Author to whom correspondence should be addressed.
Brain Sci. 2020, 10(3), 153; https://doi.org/10.3390/brainsci10030153
Received: 17 January 2020 / Revised: 2 March 2020 / Accepted: 5 March 2020 / Published: 7 March 2020
Background: Delayed cerebral vasospasm (DCVS) due to aneurysmal subarachnoid hemorrhage (aSAH) and its sequela, delayed cerebral ischemia (DCI), are associated with poor functional outcome. Endothelin-1 (ET-1) is known to play a major role in mediating cerebral vasoconstriction. Angiotensin-II-type-1-receptor antagonists such as Sartans may have a beneficial effect after aSAH by reducing DCVS due to crosstalk with the endothelin system. In this review, we discuss the role of Sartans in the treatment of stroke and their potential impact in aSAH. Methods: We conducted a literature research of the MEDLINE PubMed database in accordance with PRISMA criteria on articles published between 1980 to 2019 reviewing: “Sartans AND ischemic stroke”. Of 227 studies, 64 preclinical and 19 clinical trials fulfilled the eligibility criteria. Results: There was a positive effect of Sartans on ischemic stroke in both preclinical and clinical settings (attenuating ischemic brain damage, reducing cerebral inflammation and infarct size, increasing cerebral blood flow). In addition, Sartans reduced DCVS after aSAH in animal models by diminishing the effect of ET-1 mediated vasoconstriction (including cerebral inflammation and cerebral epileptogenic activity reduction, cerebral blood flow autoregulation restoration as well as pressure-dependent cerebral vasoconstriction). Conclusion: Thus, Sartans might play a key role in the treatment of patients with aSAH. View Full-Text
Keywords: aneurysmal subarachnoid hemorrhage; delayed cerebral vasospasm; ischemic stroke; Sartans; therapeutic interventions aneurysmal subarachnoid hemorrhage; delayed cerebral vasospasm; ischemic stroke; Sartans; therapeutic interventions
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Wanderer, S.; Grüter, B.E.; Strange, F.; Sivanrupan, S.; Di Santo, S.; Widmer, H.R.; Fandino, J.; Marbacher, S.; Andereggen, L. The Role of Sartans in the Treatment of Stroke and Subarachnoid Hemorrhage: A Narrative Review of Preclinical and Clinical Studies. Brain Sci. 2020, 10, 153.

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