Download PDF
J Neurol Surg A Cent Eur Neurosurg 2022; 83(05): 420-426
DOI: 10.1055/s-0041-1735860
Original Article

Clinical Outcome in Cerebral Vasospasm Patients Treated with and without Intra-Arterial Nimodipine Infusion

Vich Yindeedej
1   Department of Neurosurgery, Thammasat University Hospital, Pathumthani, Thailand
,
Pree Nimmannitya
1   Department of Neurosurgery, Thammasat University Hospital, Pathumthani, Thailand
,
Raywat Noiphithak
1   Department of Neurosurgery, Thammasat University Hospital, Pathumthani, Thailand
,
Prachya Punyarat
1   Department of Neurosurgery, Thammasat University Hospital, Pathumthani, Thailand
,
Dilok Tantongtip 
1   Department of Neurosurgery, Thammasat University Hospital, Pathumthani, Thailand
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Cerebral vasospasm (CV) after aneurysmal subarachnoid hemorrhage (aSAH) is still a problem. Hypertension, hypervolemia, and hemodilution (triple-H) therapy and oral nimodipine only a modest effect on patients. Intra-arterial treatment, including nimodipine, has been studied, but only as retrospective and single-arm prospective studies. We compared the outcomes between CV patients who received an adjunct intra-arterial nimodipine infusion (IANI) and those who received the standard medical treatment alone in a prospective randomized controlled trial.

Methods In this study, patients between the age of 18 and 80 years, who underwent angiography within 14 days after aneurysm obliteration, were recruited and randomized to receive adjunct IANI or not, if they were identified with angiographic vasospasm. All the angiographic and neurologic data were recorded and analyzed during their admission, at the discharge date, and during the 6-month follow-up period.

Results From June 2016 to December 2018, we enrolled 68 patients who were randomized into two groups, 36 in the intervention group and 32 in the control group. The patients' characteristics, aneurysm data, and modalities of treatment were similar between the two groups. Within 24 hours after IANI, Glasgow Coma Scale (GCS) score and motor strength revealed a significant improvement of 33.33 and 38.89%, respectively, in the intervention group versus 12.5 and 9.38%, respectively, in the control group. At discharge, the intervention group still had significant motor improvement (58.33 vs. 21.88%; p = 0.002).

Conclusion IANI could be considered an effective treatment for CV without significant complications. This is the first RCT demonstrating statistically significant motor strength improvement within 24 hours and at discharge.

Keywords

intra-arterial nimodipine - subarachnoid hemorrhage - vasospasm - intracranial aneurysm

Clinical Trial Registration

https://www.clinicaltrials.in.th/. Unique identifier: TCRC20200121002.




Publication History

Received: 05 October 2020

Accepted: 09 March 2021

Article published online:
22 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Dankbaar JW, Slooter AJC, Rinkel GJE, Schaaf IC. Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review. Crit Care 2010; 14 (01) R23
    CrossrefPubMedGoogle Scholar
  • 2 Dorhout Mees SM, Rinkel GJ, Feigin VL. et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2007; (03) CD000277
    PubMedGoogle Scholar
  • 3 Keyrouz SG, Diringer MN. Clinical review: prevention and therapy of vasospasm in subarachnoid hemorrhage. Crit Care 2007; 11 (04) 220
    CrossrefPubMedGoogle Scholar
  • 4 Eskridge JM, McAuliffe W, Song JK. et al. Balloon angioplasty for the treatment of vasospasm: results of first 50 cases. Neurosurgery 1998; 42 (03) 510-516 , discussion 516–517
    CrossrefPubMedGoogle Scholar
  • 5 Hoh BL, Ogilvy CS. Endovascular treatment of cerebral vasospasm: transluminal balloon angioplasty, intra-arterial papaverine, and intra-arterial nicardipine. Neurosurg Clin N Am 2005; 16 (03) 501-516 , vi
    CrossrefPubMedGoogle Scholar
  • 6 Biondi A, Ricciardi GK, Puybasset L. et al. Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. AJNR Am J Neuroradiol 2004; 25 (06) 1067-1076
    PubMedGoogle Scholar
  • 7 Hui C, Lau KP. Efficacy of intra-arterial nimodipine in the treatment of cerebral vasospasm complicating subarachnoid haemorrhage. Clin Radiol 2005; 60 (09) 1030-1036
    CrossrefPubMedGoogle Scholar
  • 8 Hänggi D, Turowski B, Beseoglu K, Yong M, Steiger HJ. Intra-arterial nimodipine for severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage: influence on clinical course and cerebral perfusion. AJNR Am J Neuroradiol 2008; 29 (06) 1053-1060
    CrossrefPubMedGoogle Scholar
  • 9 Kim JH, Park IS, Park KB, Kang DH, Hwang SH. Intraarterial nimodipine infusion to treat symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc 2009; 46 (03) 239-244
    CrossrefPubMedGoogle Scholar
  • 10 Cho WS, Kang HS, Kim JE. et al. Intra-arterial nimodipine infusion for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. Interv Neuroradiol 2011; 17 (02) 169-178
    CrossrefPubMedGoogle Scholar
  • 11 Kim SS, Park DH, Lim DJ, Kang SH, Cho TH, Chung YG. Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm. J Korean Neurosurg Soc 2012; 52 (03) 172-178
    CrossrefPubMedGoogle Scholar
  • 12 Hockel K, Diedler J, Steiner J. et al. Long-term, continuous intra-arterial nimodipine treatment of severe vasospasm after aneurysmal subarachnoid hemorrhage. World Neurosurg 2016; 88: 104-112
    CrossrefPubMedGoogle Scholar
  • 13 Chiriac A, Georgiana I, Dobrin N, Faiyad Z, Poeată I. Intra-arterial nimodipine for the treatment of vasospasm due to aneurysmal subarachnoid hemorrhage. Romanian Neurosurgery 2016; 30 (04) 461-466
    CrossrefPubMedGoogle Scholar
  • 14 Bashir A, Andresen M, Bartek Jr J, Cortsen M, Eskesen V, Wagner A. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: influence on clinical course and predictors of clinical outcome. Neuroradiol J 2016; 29 (01) 72-81
    CrossrefPubMedGoogle Scholar
  • 15 Goel R, Aggarwal A, Salunke P, Kumar A, Chhabra R. Is intra arterial nimodipine really beneficial in vasospasm following aneurysmal subarachnoid haemorrhage?. Br J Neurosurg 2016; 30 (04) 407-410
    CrossrefPubMedGoogle Scholar
  • 16 Park K, Kim B, Park D, Lee N. E-024 Intra-arterial nimodipine injection for the treatment of cerebral vasospasm following aneurysm subarachnoid hemorrhageand the factors associated with delayed cerebral infarction. J Neurointerv Surg 2017; 9 (Suppl. 01) A52-A52
    PubMedGoogle Scholar
  • 17 Narayan V, Pendharkar H, Devi BI, Bhat DI, Shukla DP. Aggressive management of vasospasm with direct intra-arterial nimodipine therapy. Neurol India 2018; 66 (02) 416-422
    CrossrefPubMedGoogle Scholar
  • 18 Sriganesh K, Venkataramaiah S, Palaniswamy SR, Ramalingaiah AH. Effect of intra-arterial nimodipine on cerebral oxygen saturation and systemic hemodynamic indices in patients with cerebral vasospasm: a prospective cohort study. J Neurosurg Anesthesiol 2019
    PubMedGoogle Scholar
  • 19 Kaufmann TJ, Huston III J, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF. Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology 2007; 243 (03) 812-819
    CrossrefPubMedGoogle Scholar
  • 20 Fifi JT, Meyers PM, Lavine SD. et al. Complications of modern diagnostic cerebral angiography in an academic medical center. J Vasc Interv Radiol 2009; 20 (04) 442-447
    CrossrefPubMedGoogle Scholar
  • 21 Seker F, Hesser J, Brockmann MA. et al. Pharmacokinetic modeling of intra-arterial nimodipine therapy for subarachnoid hemorrhage-related cerebral vasospasm. Clin Neuroradiol 2015
    PubMedGoogle Scholar