Effect of intra-arterial nimodipine on iatrogenic vasospasms during endovascular stroke treatment – angiographic resolution and infarct growth in follow-up imaging

Jesser, Jessica; Potreck, Arne; Vollherbst, Dominik F; Şeker, Fatih; Chen, Min; Schönenberger, Silvia; Duong, Thuy; Bendszus, Martin; Möhlenbruch, Markus; Weyland, Charlotte S.

doi:10.1186/s12883-022-03045-x

Cited by 6 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While we do not know if the presence of vasospasm during EVT can influence technical reperfusion success or the patient's outcome, CCBs are known to reverse vasospasm in the majority of cases and some EVT patients experiencing vasospasm Open access might show higher infarct volumes despite vasospasm being a transient phenomenon. 12 Future studies on this subject may be influenced by differing treatment gies, as we learnt from this study. Spasmolytic agents, such as CCBs, decrease the systemic blood pressure due to their vasodilation effect.…”

Section: Discussionmentioning

confidence: 81%

“…Intra-arterial application of vasodilators, such as calcium channel blockers (CCBs), can resolve vasospasm in most cases. 12 CCBs can be added to catheter flushes to prevent vasospasm during EVT or they can be given intra-arterially via the intermediate or guide catheter after detection of vasospasm. Withdrawal of the catheter from the affected vessel and waiting is another strategy to manage vasospasm.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

See 1 more Smart Citation

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Jesser,

Nguyen,

Dmytriw

et al. 2023

Stroke Vasc Neurol

Self Cite

View full text Add to dashboard Cite

Background and aimThe clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT.MethodsWe conducted an anonymous international online survey (4 April 2023 to 15 May 2023) addressing treatment standards of neurointerventionalists (NIs) practising EVT. Several illustrative cases of patients with vasospasm during EVT were shown. Two study groups were compared according to the NI’s opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis.ResultsIn total, 534 NI from 56 countries responded, of whom 51.5% had performed >200 EVT. Vasospasm was considered a complication potentially influencing the patient’s outcome by 52.6% (group 1) whereas 47.4% did not (group 2). Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely (43.7% vs 33.9%, p=0.033) and more often treated severe large-vessel vasospasm with vasodilators (75.3% vs 55.9%; p<0.001), as well as extracranial vasospasm (61.4% vs 36.5%, p<0.001) and intracranial medium-vessel vasospasm (27.1% vs 11.2%, p<0.001), compared with group 2. In case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT, the study groups showed different treatment strategies. Group 2 continued the EVT immediately more often, without initiating therapy to treat the vasospasm first (9.6% vs 21.1%, p<0.001).ConclusionThere is disagreement among NIs about the clinical relevance of vasospasm during EVT and its management. There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.

show abstract

Section: Discussionmentioning

confidence: 81%

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Jesser,

Nguyen,

Dmytriw

et al. 2023

Stroke Vasc Neurol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Interestingly, the interventionalist's opinion on the clinical relevance of vasospasm during EVT was associated with different treatment strategies. While we do not know if the presence of vasospasm during EVT can influence technical reperfusion success or the patient's outcome, calcium channel blockers are known to reverse vasospasm in the majority of cases and some EVT patients experiencing vasospasm might show higher infarct volumes despite vasospasm being a transient phenomenon [12]. Future studies on this subject may be influenced by differing treatment strategies, as we learned from this study.…”

Section: Discussionmentioning

confidence: 89%

“…Intra-arterial application of vasodilators, such as calcium channel blockers (CCBs), can resolve vasospasm in most cases [12]. CCBs can be added to catheter flushes to prevent vasospasm during EVT or they can be given intra-arterially via the intermediate or guide catheter after detection of vasospasm.…”

Section: Introductionmentioning

confidence: 99%

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Jesser,

Nguyen,

Dmytriw

et al. 2023

Preprint

View full text Add to dashboard Cite

Background and aim: The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT. Methods: We conducted an anonymous international online survey (April 04th to May 15th 2023) addressing treatment standards of neurointerventionalists (NI) practicing EVT. Several illustrative cases of patients with vasospasm during EVT were shown. Two study groups were compared according to the NI's opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis. Results: In total, 534 NI from 56 countries responded, of whom 51.5% had performed more than 200 EVT. Vasospasm was considered a complication potentially influencing the patient's outcome by 52.6% (Group 1) whereas 47.4% did not (Group 2). Physicians in Group 1 more often added vasodilators to their catheter flushes during EVT routinely (43.7% vs. 33.9%, p = 0.033) and more often treated severe large-vessel vasospasm with vasodilators (75.3% vs. 55.9%; p < 0.001), as well as extracranial vasospasm (61.4% vs. 36.5%, p < 0.001) and intracranial medium-vessel vasospasm (27.1% vs. 11.2%, p < 0.001), compared to Group 2. In case of a large-vessel vasospasm and residual and amenable medium vessel occlusion during EVT, the study groups showed different treatment strategies. Group 2 continued the EVT immediately more often, without initiating therapy to treat the vasospasm first (9.6% vs 21.1%, p < 0.001). Conclusion: There is disagreement among neurointerventionalists about the clinical relevance of vasospasm during EVT and its management. There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.

show abstract

“…Intra-arterial application of vasodilators, such as calcium channel blockers (CCBs), can resolve vasospasm in most cases [8]. CCBs can be added to catheter flushes to prevent vasospasm during EVT or they can be given as an intraarterial bolus via the intermediate or guide catheter after detection of vasospasm.…”

Section: Introductionmentioning

confidence: 99%

Nimodipine as Vasodilator in Guide Catheter Flush to Prevent Vasospasm During Endovascular Stroke Treatment

Sommer,

Jesser,

Nikoubashman

et al. 2024

Clin Neuroradiol

Self Cite

View full text Add to dashboard Cite

Purpose The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate the effect of adding nimodipine to the guiding catheter flush (GCF) to prevent vasospasm during EVT. Methods This is a single-center retrospective analysis including patients with EVT (stent-retriever and/or distal aspiration) treated for anterior or posterior circulation intracranial vessel occlusion from January 2018 to June 2023. Exclusion criteria were intracranial or extracranial stenosis, intra-arterial alteplase, patient age over 80 years. Study groups were patients with (nimo+) and without (nimo−) nimodipine in the GCF. They were compared for occurrence of vasospasm as primary endpoint and clinical outcome in univariate analysis. Results 477 patients were included in the analysis (nimo+ n = 94 vs. nimo− n = 383). Nimo+ patients experienced less vasospasm during EVT (e.g. vasospasm in target vessel n (%): nimo− = 113 (29.6) vs. nimo+ = 9 (9.6), p < 0.001; extracranial vasospasm, n (%): nimo− = 68 (17.8) vs. nimo+ = 7 (7.4), p = 0.017). Patients of the two study groups had a comparable clinical outcome (90 day mRS, median (IQR): 3 (1–6) for both groups, p = 0.896). In general, patients with anterior circulation target vessel occlusion (TVO) experienced more vasospasm (anterior circ. TVO 38.7% vs. posterior circ. 7.5%, p = 0.006). Conclusion Prophylactic adding of nimodipine reduces the risk of vasospasm during EVT without affecting the clinical outcome. Patients with anterior circulation TVO experienced more vasospasm compared to posterior circulation TVO.

show abstract

Effect of intra-arterial nimodipine on iatrogenic vasospasms during endovascular stroke treatment – angiographic resolution and infarct growth in follow-up imaging

Cited by 6 publications

References 20 publications

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Treatment practice of vasospasm during endovascular thrombectomy: an international survey

Nimodipine as Vasodilator in Guide Catheter Flush to Prevent Vasospasm During Endovascular Stroke Treatment

Contact Info

Product

Resources

About