• Abhishek Kotwal, Arvinda Hanumanthapura Ramalingaiah, Dhaval Shukla, Muthuchellappan Radhakrishnan, Subhas Kanti Konar, Bharath Srinivasaiah, Dhritiman Chakrabarti, and Mouleeswaran Sundaram.
• Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
• World Neurosurg. 2022 Oct 1; 166: e285e293e285-e293.

ObjectiveThe role of nimodipine and milrinone in the management of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) was studied using clinical and TCD (transcranial Doppler) parameters.MethodsIn this prospective observational study, patients with DCI after aneurysmal SAH presenting between November 2020 and June 2021 who were treated by either intra-arterial nimodipine (IAN) or intravenous milrinone (IVM) were included after excluding patients in whom both IAN and IVM had been given or mechanical angioplasty was performed. Twelve-hourly TCD was performed during the course of the therapy. Clinical improvement and the development of new brain infarcts were also assessed. A P value <0.05 was considered statistically significant.ResultsThirty-four patients fulfilled the inclusion criteria (IVM, 13/34 [38%]; IAN, 21/34 [62%]); patients in the IVM group (vs. IAN group) had poorer median Glasgow Coma Scale score (12 vs. 13), poorer motor response (ConclusionsIn this single-center small study, patients in the IAN group had significantly less mortality compared with the IVM group in the management of DCI after aneurysmal SAH.Copyright © 2022 Elsevier Inc. All rights reserved.

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