Abstract | BACKGROUND: METHODS: Between 0.5 and 1.2 mg/h of nimodipine were continuously administered by intra-arterial infusion via microcatheters either into the internal carotid or vertebral artery or both, depending on the areas of vasospasm. The effect was controlled via multimodal neuromonitoring and transcranial Doppler sonography. Outcome was determined by means of the Glasgow Outcome Scale at discharge and 6 months after the hemorrhage and compared to a historical control group. RESULTS: Twenty-one patients received 28 intra-arterial nimodipine infusions. Six months after discharge, the occurrence of cerebral infarctions was significantly lower (42.6 %) in the nimodipine group than in the control group (75.0 %). This result was reflected by a significantly higher proportion (76.0 %) of patients with good outcome in the nimodipine-treated group, when compared to 10.0 % good outcome in the control group. Median GOS was 4 in the nimodipine group and 2 in the control group (p = 0.001). CONCLUSIONS: Continuous intra-arterial nimodipine infusion is an effective treatment for patients with severe cerebral vasospasm who fail to respond to HHT and oral nimodipine alone. Key to the effective administration of continuous intra-arterial nimodipine is multimodal neuromonitoring and the individual adaptation of dosage and time of infusion for each patient.
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Authors | Sylvia Bele, Martin A Proescholdt, Andreas Hochreiter, Gerhard Schuierer, Judith Scheitzach, Christina Wendl, Martin Kieninger, Andre Schneiker, Elisabeth Bründl, Petra Schödel, Karl-Michael Schebesch, Alexander Brawanski |
Journal | Acta neurochirurgica
(Acta Neurochir (Wien))
Vol. 157
Issue 12
Pg. 2041-50
(Dec 2015)
ISSN: 0942-0940 [Electronic] Austria |
PMID | 26439105
(Publication Type: Journal Article)
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Chemical References |
- Calcium Channel Blockers
- Nimodipine
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Topics |
- Adult
- Calcium Channel Blockers
(administration & dosage, therapeutic use)
- Female
- Humans
- Infusions, Intra-Arterial
- Male
- Middle Aged
- Nimodipine
(administration & dosage, therapeutic use)
- Subarachnoid Hemorrhage
(complications, drug therapy)
- Vasospasm, Intracranial
(drug therapy, etiology)
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