Intra-Arterial Nimodipine for Severe Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Influence on Clinical Course and Cerebral Perfusion

Abstract

BACKGROUND AND PURPOSE:The efficacy of intra-arterial administration of nimodipine (IAN) in patients with severe vasospasm after aneurysmal subarachnoid hemorrhage (SAH) remains unproved. The goal of the present study was to investigate the clinical effect and cerebral perfusion after IAN in patients with severe vasospasm refractory to hemodynamic treatment.

Vasogenic Edema of the Basal Ganglia after Intra-Arterial Administration of Nimodipine for Treatment of Vasospasm

“…Several studies have shown that intra-arterially administered nimodipine is safe and effective for the treatment of cerebral vasospasm. The only complications of IAN reported in previous studies have been transient hypotension and bradycardia 1,5) . Oral and intravenous administration of nimodipine has been shown to promote improvement of regional cerebral blood flow in patients with vasospasm after SAH 3,10) .…”

“…The timely application of endovascular procedures, including balloon angioplasty and intra-arterial infusion of vasodilating agents, is effective at reducing the vasospasm intractable to medical treatment. Intra-arterial infusion of nimodipine (IAN) has been regarded as safe and well tolerated in patients with cerebral vasospasm after SAH 5,10) . Transient hypotension and bradycardia are the only reported adverse effects of IAN.…”

Intra-Arterial Nimodipine Infusion for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

“…transient decrease in blood pressure normally recovered within a few minutes. no neurological complications have been reported from the use of nimodipine in the literature 7,13,14 . In other studies with verapamil and nicardipine, complication rates ranged from 0% to 36.4%, and most of them were procedure-related complications and transient hypotension 6,11,17,21,23,25 .…”

The results of Selective Intraarterial Papaverine Treatment Effect on Subarachnoidal Hemorrhage related Vasospasm

“…İntraarteriyel papaverin kullanımı sonrasında serebral hipoperfüzyon ve sonrasında kan akım hızında artma gibi bulgular transkranyal doppler ultrason kan akım hızı çalışmalarında gösterilmiştir (21) . Çoklu tedavileri gerektiren geçici etkisi ile beraber, papaverin kullanı-mının diğer bazı yan etkileri de mevcuttur.…”

“…Çoklu tedavileri gerektiren geçici etkisi ile beraber, papaverin kullanı-mının diğer bazı yan etkileri de mevcuttur. En ciddi ve hasar verebilen etkisi intrakraniyal basınçtaki artış (14,15,(22)(23)(24) , VS'ın kötüleşmesi, nörolojik bozulma ile gri madde hasarı (20,21,25) , beyin kök depresyonu (posterior sirkülasyonda kullanılması durumunda dikkat edilmelidir), nöbetler, kristal emboli oluşumuna ikincil olarak meydana gelen monoküler körlük ve geçici fokal nörolojik hasarlar olarak sıralanabilir (1,26) .…”