Intra-arterial nimodipine infusion for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

W-S Cho, H-S Kang, J E Kim, O-K Kwon, C W Oh, Y J Son, B J Know, C Jung, M H Hang, W-S Cho, H-S Kang, J E Kim, O-K Kwon, C W Oh, Y J Son, B J Know, C Jung, M H Hang

Abstract

This study evaluated the efficacy of intra-arterial nimodipine infusion for symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Clinical data collected from 42 consecutive patients with symptomatic vasospasm after aSAH were retrospectively reviewed. Forty-two patients underwent 101 sessions of intra-arterial nimodipine infusion. Angiographic response, immediate clinical response, and clinical outcome were evaluated at discharge and six months later. Angiographic improvement was achieved in 82.2% of patients. The immediate clinical improvement rate was 68.3%, while the deterioration rate was 5.0%. A favorable clinical outcome was achieved in 76.2% at discharge and 84.6% six months. Vasospasm-related infarction occurred in 21.4%. There was no drug-related complication. The nimodipine group showed satisfactory outcomes. Nimodipine can be recommended as an effective and safe intra-arterial agent for the treatment of symptomatic vasospasm after aSAH.

Figures

Figure 1
Figure 1
30-year-old male with Hunt and Hess grade III and Fisher’s group 3 were treated for the aneurysm at the left middle cerebral artery (MCA) with coil embolization on the day of initial bleeding (A). On the 6th day after the initial bleeding, vasospasm more than 50% at the left MCA was identified with altered mentality (arrows) (B). After 7 intra-arterial nimodipine infusions, MCA was almost normalized (grade 1) (C). There was no vasospasm-related infarction at discharge and the patient returned to his workplace.
Figure 2
Figure 2
Distribution of the interval between bleeding and intra-arterial nimodipine infusion for the symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage. Mean interval between initial bleeding and initial treatment for the symptomatic vasospasm was 8.5±5.0 days (range, 0-24 d) (A). Mean interval between initial bleeding and total vasospasm therapy (including repeated procedures) was 10.1±5.4 days (range, 0-27 d) (B).

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