Background: Cerebral vasospasm (CVS) continues to account for high morbidity and
mortality in patients surviving the initial aneurysmal subarachnoid hemorrhage (SAH).
Nimodipine is the only drug known to reduce delayed cerebral ischemia (DCI), but it
is believed not to affect large vessel CVS. Milrinone has emerged as a promising option.
Our retrospective study focused on the effectiveness of the intra-arterial application of
both drugs in monotherapy and combined therapy.
Methods: We searched for patients with aneurysmal SAH, angiographically confirmed
CVS, and at least one intra-arterial pharmacological angioplasty. Ten defined vessel
sections on angiograms were assessed before and after vasodilator infusion. The
improvement in vessel diameters was compared to the frequency of DCI-related cerebral
infarction before hospital discharge and functional outcome reported as the modified
Rankin Scale (mRS) score after 6 months.
Results: Between 2014 and 2021, 132 intra-arterial interventions (144 vascular
territories, 12 bilaterally) in 30 patients were analyzed for this study. The vasodilating
effect of nimodipine was superior to milrinone in all intradural segments. There was
no significant intergroup difference concerning outcome in mRS (p = 0.217). Only
nimodipine or the combined approach could prevent DCI-related infarction (both 57.1%),
not milrinone alone (87.5%). Both drugs induced a doubled vasopressor demand due to
blood pressure decrease, but milrinone alone induced tachycardia.
Conclusions: The monotherapy with intra-arterial nimodipine was superior to milrinone.
Nimodipine and milrinone may be used complementary in an escalation scheme with the
administration of nimodipine first, complemented by milrinone in cases of severe CVS.
Milrinone monotherapy is not recommended.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:87453 |
| Date | 17 October 2023 |
| Creators | Jentzsch, Jennifer, Ziganshyna, Svitlana, Lindner, Dirk, Merkel, Helena, Mucha, Simone, Schob, Stefan, Quäschling, Ulf, Hoffmann, Karl-Titus, Werdehausen, Robert, Halama, Dirk, Gaber, Khaled, Richter, Cindy |
| Publisher | Frontiers Media S.A. |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 939015, 10.3389/fneur.2022.939015 |
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