Endothelins and the role of endothelin antagonists in the management of posttraumatic vasospasm.

Increasing evidence implicates endothelin in the pathophysiological development of cerebral vasospasm. This review summarizes background topics such as the structures and biosynthesis of endothelins, the types of endothelin and their receptors, as well as their biological effects. Basic science and clinical observations supportive of the role of endothelins in the spasm associated with stroke and subarachnoid hemorrhage are presented. Similar basic science and clinical observations are presented regarding the role of endothelins in impaired cerebral hemodynamics following traumatic brain injury, cryogenic cortical lesion injury and fluid percussion brain injury. The role of age in the contribution of endothelin to impaired cerebral hemodynamics following fluid percussion brain injury is discussed. Finally, potential mechanisms for endothelin contributions to vasospasm following fluid percussion brain injury such as impaired K+ channel function are described.