J Korean Neurosurg Soc.  2009 Sep;46(3):239-244. 10.3340/jkns.2009.46.3.239.

Intraarterial Nimodipine Infusion to Treat Symptomatic Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

• Kim JH
• Park IS
• Park KB
• Kang DH
• Hwang SH

• KMID: 2138413
• DOI: http://doi.org/10.3340/jkns.2009.46.3.239

Abstract

OBJECTIVE
Cerebral vasospasm leading to cerebral ischemic infarction is a major cause of morbidity and mortality in the patients who suffer with aneurysmal subarachnoid hemorrhage. Despite adequate treatment, some patients deteriorate and they develop symptomatic vasospasm. The objective of the present study was to investigate the efficacy and clinical outcome of intraarterial nimodipine infusion on symptomatic vasospasm that is refractory to hemodynamic therapy. METHODS: We retrospectively reviewed the procedure reports, the clinical charts and the transcranial doppler, computed tomography and digital subtraction angiography results for the patients who underwent endovascular treatment for symptomatic cerebral vasospasm due to aneurysmal SAH. During the 36 months between Jan. 2005 and Dec. 2007, 19 patients were identified who had undergone a total of 53 procedures. We assessed the difference in the arterial vessel diameter, the blood flow velocity and the clinical outcome before and after these procedures. RESULTS: Vascular dilatation was observed in 42 of 53 procedures. The velocities of the affected vessels before and after procedures were available in 33 of 53 procedures. Twenty-nine procedures exhibited a mean decrease of 84.1 cm/s. We observed clinical improvement and an improved level of consciousness with an improved GCS score after 23 procedures. CONCLUSION: Based on our results, the use of intraarterial nimodipine is effective and safe in selected cases of vasospasm following aneurysmal SAH. Prospective, randomized studies are needed to confirm these results.

Keyword

Subarachnoid hemorrhage; Vasospasm; Intraarterial nimodipine infusion

MeSH Terms

Aneurysm
Angiography, Digital Subtraction
Blood Flow Velocity
Consciousness
Dilatation
Glycosaminoglycans
Hemodynamics
Humans
Infarction
Nimodipine
Retrospective Studies
Subarachnoid Hemorrhage
Vasospasm, Intracranial
Glycosaminoglycans
Nimodipine