• AJNR Am J Neuroradiol · Jun 2004

    Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results.

    • Alessandra Biondi, Giuseppe K Ricciardi, Louis Puybasset, Lamine Abdennour, Marcello Longo, Jacques Chiras, and Rémy Van Effenterre.
    • Department of Neuroradiology, Pitie-Salpetriere Hospital-Paris VI University, Paris, France.
    • AJNR Am J Neuroradiol. 2004 Jun 1; 25 (6): 1067-76.

    Background And PurposeCerebral vasospasm remains a major problem in patients recovering from aneurysmal subarachnoid hemorrhage despite advances in medical, surgical, and endovascular care. Our purpose was to assess the efficacy of intra-arterial nimodipine, a calcium-channel blocker acting mainly on cerebral vessels, in preventing delayed neurologic deficits in patients with symptomatic vasospasm.MethodsClinical charts of 25 consecutively treated patients were retrospectively reviewed. A multifactorial decision tree was used to determine the indication for angiography and subsequent endovascular treatment. Nimodipine was infused intra-arterially via a diagnostic catheter in the internal carotid artery or vertebral artery at a rate of 0.1 mg/min. Angiographic vasospasm before endovascular treatment, immediate vessel caliber modifications, and short- and long-term clinical efficacy of the procedure were assessed.ResultsThirty procedures were performed in 25 patients. Clinical improvement was observed in 19 (76%), 16 of whom improved after the first endovascular procedure, two after the second intra-arterial treatment, and one after the third. Of these 19 patients, only 12 (63%) had notable vascular dilatation at postprocedural angiography. Dilatation of infused vessels occurred in only 13 (43%) of 30 procedures. After follow-up of 3-6 months, 18 (72%) of 25 patients had a favorable outcome (Glasgow outcome scale score of 1-2 and modified Rankin scale score of 0-2). No complications were observed.ConclusionIntra-arterial nimodipine is effective and safe for the treatment of symptomatic vasospasm after subarachnoid hemorrhage. Further prospective randomized studies of cerebral blood flow are needed to confirm these results.

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