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Published in: Acta Neurochirurgica 12/2015

01-12-2015 | Clinical Article - Vascular

Continuous intra-arterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a feasibility study and outcome results

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

Published in: Acta Neurochirurgica | Issue 12/2015

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Abstract

Background

Severe cerebral vasospasm is a major cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. No causative treatment is yet available and hypertensive hypervolemic therapy (HHT) is often insufficient to avoid delayed cerebral ischemia and neurological deficits. We compared patients receiving continuous intra-arterial infusion of the calcium-antagonist nimodipine with a historical group treated with HHT and oral nimodipine alone.

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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Metadata
Title
Continuous intra-arterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a feasibility study and outcome results
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
Publication date
01-12-2015
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 12/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-015-2597-z

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