Continuous local intra-arterial nimodipine administration in severe symptomatic vasospasm after subarachnoid hemorrhage

Christian Musahl, Hans Henkes, Z. Vajda, Jan Coburger, Nikolai Hopf

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Cerebral vasospasm (CV) is a potentially disastrous consequence of subarachnoid hemorrhage despite medical treatment. Nimodipine is a potent drug for vessel relaxation, but side effects may preclude a sufficient dose. Objective: To explore whether continuous local intra-arterial nimodipine administration (CLINA) can reverse vasospasm and prevent delayed ischemic neurological deficit. Methods: Six consecutive subarachnoid hemorrhage patients (5 women; mean age, 47.2 years) with severe CV despite maximum medical therapy underwent CLINA within 2 hours after the onset of clinical symptoms. After anticoagulation, microcatheters were inserted distally in the concerning supra-aortic vessels. Glyceryl trinitrate injection (2 mg) was followed by CLINA (nimodipine 0.4 mg/h for 70-147 hours). Duration of CLINA was determined by neurological status, transcranial Doppler sonography, and partial tissue oxygen pressure values. Results: In all patients, neurological deficits improved or partial tissue oxygen pressure values returned to normal and transcranial Doppler sonography confirmed a reduced blood flow velocity within 12 hours. Magnetic resonance imaging showed no ischemic lesion caused by CV. Neurological outcome was good (modified Rankin Scale score, 0-2) in 3 patients, whereas 1 patient had a moderate clinical outcome (modified Rankin Scale score, 3-4) and 2 patients had a poor outcome (modified Rankin Scale score, 5) because of the SAH. Conclusion: Preliminary data show that CLINA is a straightforward, effective, and safe option for patients with severe CV refractory to medical therapy. Dilation of spastic arteries starts within a few hours and is lasting. Indication for CLINA is peripheral and diffuse CV at any location.

Original languageEnglish
Pages (from-to)1541-1547
Number of pages7
JournalNeurosurgery
Volume68
Issue number6
DOIs
Publication statusPublished - Jun 2011

Fingerprint

Nimodipine
Subarachnoid Hemorrhage
Intracranial Vasospasm
Doppler Transcranial Ultrasonography
Oxygen
Pressure
Muscle Spasticity
Blood Flow Velocity
Nitroglycerin
Dilatation
Therapeutics
Arteries
Magnetic Resonance Imaging
Injections

Keywords

  • DIND
  • Intra-arterial nimodipine
  • Subarachnoid hemorrhage
  • Triple-H therapy
  • vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Continuous local intra-arterial nimodipine administration in severe symptomatic vasospasm after subarachnoid hemorrhage. / Musahl, Christian; Henkes, Hans; Vajda, Z.; Coburger, Jan; Hopf, Nikolai.

In: Neurosurgery, Vol. 68, No. 6, 06.2011, p. 1541-1547.

Research output: Contribution to journalArticle

Musahl, Christian ; Henkes, Hans ; Vajda, Z. ; Coburger, Jan ; Hopf, Nikolai. / Continuous local intra-arterial nimodipine administration in severe symptomatic vasospasm after subarachnoid hemorrhage. In: Neurosurgery. 2011 ; Vol. 68, No. 6. pp. 1541-1547.
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