Milrinone as a Rescue Therapy for Symptomatic Refractory Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Romero, César; Morales, Diego; Reccius, Andrés; Mena, Francisco; Prieto, Juan Carlos; Bustos, Patricia; Larrondo, Jorge; Castro, Jéssica

doi:10.1007/s12028-008-9048-0

Cited by 40 publications

(21 citation statements)

References 30 publications

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“…Based on previously published data [16][17][18][19], patients are also administered intravenous milrinone, a phosphodiesterase III inhibitor, initially as a bolus of 0.05-0.1 mg/kg followed by an intravenous infusion titrated stepwise to a maximum of 1.5 lg/kg/min according to clinical response. Those who do not improve despite maximal medical therapy undergo angiography and assessment for possible endovascular therapy.…”

Section: Management Of DCImentioning

confidence: 99%

Using Continuous Electroencephalography in the Management of Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage

et al. 2011

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Section: Management Of DCImentioning

confidence: 99%

Using Continuous Electroencephalography in the Management of Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage

et al. 2011

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“…Milrinone is an inhibitor of phosphodiesterase III, with positive inotropic and vasodilatory effects . Although intra‐arterial milrinone contributes to the reduction of VSP, this usually requires concomitant use of angiography .…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral vasospasm is a main cause of morbidity and mortality following aneurysmal SAH and contributes to delayed cerebral ischemia (DCI). 1 VSP occurs around the fourth day after SAH and usually peaks between seven and ten days. 1 Moreover, this condition is a persistent state of vasoconstriction, which is present in 70% of the patients who survive the first 24 hours after SAH.…”

Section: Introductionmentioning

confidence: 99%

Intravenous administration of Milrinone, as an alternative approach to treat vasospasm in subarachnoid hemorrhage: A case report of transcranial Doppler monitoring

Santos‐Teles

Passos

Panerai

et al. 2019

Clinical Case Reports

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“…Recently, two studies have also shown that IA milrinone appears to be safe and effective in the treatment of SAH-induced vasospasm [103,104]. Fraticelli et al [103] studied the effects of IA milrinone (8-24 mg) followed by intravenous milrinone infusion in 22 patients with cerebral vasospasm.…”

Section: Endovascular Therapy In Sah-induced Cerebral Vasospasmmentioning

confidence: 99%

Current Options for the Management of Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm: A Comprehensive Review of the Literature

2013

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Objectives: Cerebral vasospasm is one of the leading causes of morbi-mortality following aneurysmal subarachnoid hemorrhage. The aim of this article is to discuss the current status of vasospasm therapy with emphasis on endovascular treatment. Methods: A comprehensive review of the literature obtained by a PubMed search. The most relevant articles related to medical, endovascular and alternative therapies were selected for discussion. Results: Current accepted medical options include the oral nimodipine and ‘triple-H' therapy (hypertension, hypervolemia and hemodilution). Nimodipine remains the only modality proven to reduce the incidence of infarction. Although widely used, ‘triple-H' therapy has not been demonstrated to significantly change overall outcome after cerebral vasospasm. Indeed, both induced hypervolemia and hemodilution may have deleterious effects, and more recent physiologic data favor normovolemia with induced hypertension or optimization of cardiac output. Endovascular options include percutaneous transluminal balloon angioplasty (PTA) and intra-arterial (IA) infusion of vasodilators. Multiple case reports and case series have been encountered in the literature using different drug regimens with diverse mechanisms of action. Compared with PTA, IA drug infusion has the advantages of distal penetration and a better safety profile. Its main disadvantages are the more frequent need for repeat treatments and its systemic hemodynamic repercussions. Alternative options using intraventricular/cisternal drug therapy and flow augmentation strategies have also shown possible benefits; however, their use is not yet as well established. Conclusion: Blood pressure or cardiac output optimization should be the mainstay of hyperdynamic therapy. Endovascular treatment appears to have a positive impact on neurological outcome compared with the natural history of the disease. The role of intraventricular therapy and flow augmentation strategies in association with medical and endovascular treatment may, in the future, play a growing role in the management of patients with severe refractory vasospasm.

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Milrinone as a Rescue Therapy for Symptomatic Refractory Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Abstract: Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

Cited by 40 publications

References 30 publications

Using Continuous Electroencephalography in the Management of Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage

Using Continuous Electroencephalography in the Management of Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage

Intravenous administration of Milrinone, as an alternative approach to treat vasospasm in subarachnoid hemorrhage: A case report of transcranial Doppler monitoring

Current Options for the Management of Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm: A Comprehensive Review of the Literature

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