Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results.

Abstract

BACKGROUND AND PURPOSE:

Cerebral vasospasm remains a major problem in patients recovering from aneurysmal subarachnoid hemorrhage despite advances in medical, surgical, and endovascular care. Our purpose was to assess the efficacy of intra-arterial nimodipine, a calcium-channel blocker acting mainly on cerebral vessels, in preventing delayed neurologic deficits in patients with symptomatic vasospasm.

METHODS:

Clinical charts of 25 consecutively treated patients were retrospectively reviewed. A multifactorial decision tree was used to determine the indication for angiography and subsequent endovascular treatment. Nimodipine was infused intra-arterially via a diagnostic catheter in the internal carotid artery or vertebral artery at a rate of 0.1 mg/min. Angiographic vasospasm before endovascular treatment, immediate vessel caliber modifications, and short- and long-term clinical efficacy of the procedure were assessed.

RESULTS:

Thirty procedures were performed in 25 patients. Clinical improvement was observed in 19 (76%), 16 of whom improved after the first endovascular procedure, two after the second intra-arterial treatment, and one after the third. Of these 19 patients, only 12 (63%) had notable vascular dilatation at postprocedural angiography. Dilatation of infused vessels occurred in only 13 (43%) of 30 procedures. After follow-up of 3-6 months, 18 (72%) of 25 patients had a favorable outcome (Glasgow outcome scale score of 1-2 and modified Rankin scale score of 0-2). No complications were observed.

CONCLUSION:

Intra-arterial nimodipine is effective and safe for the treatment of symptomatic vasospasm after subarachnoid hemorrhage. Further prospective randomized studies of cerebral blood flow are needed to confirm these results.

• Authors: Alessandra Biondi, Giuseppe K Ricciardi, Louis Puybasset, Lamine Abdennour, Marcello Longo, Jacques Chiras, Rémy Van Effenterre
• Journal: AJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) 2004 Jun-Jul Vol. 25 Issue 6 Pg. 1067-76 ISSN: 0195-6108 [Print] United States
• PMID: 15205150 (Publication Type: Journal Article)

Chemical References

• Calcium Channel Blockers
• Nimodipine

Topics

• Adult
• Angiography
• Calcium Channel Blockers (administration & dosage)
• Female
• Humans
• Infusions, Intra-Arterial
• Male
• Middle Aged
• Nimodipine (administration & dosage)
• Retrospective Studies
• Subarachnoid Hemorrhage (complications)
• Vasospasm, Intracranial (diagnostic imaging, drug therapy, etiology)