Preventive nimodipine and acute aneurysm surgery. Heading for the control of complications after aneurysmal subarachnoid hemorrhage.
Experimental and clinical studies have been performed to investigate the validity of a pharmacological approach to prevent delayed ischemic neurologic deficit from vasospasm after subarachnoid hemorrhage: the calcium channel blocker nimodipine was administered intravenously and perivascularly. Pial arteries of cat dilated by 25% during 1 microgram/kg-1 min-1 intravenous infusion; perivascular application of a 2.4 X 10(-5) M solution induced a 21% dilatation, the ethanol-containing solvent alone a 6% dilatation. A 1 microgram/kg-1 min-1 intravenous infusion of nimodipine in patients during EC-IC bypass operation led to a 16% dilatation of pial arteries; the solvent remained without effect. Perivascular application of a 2.4 X 10(-5) M solution during aneurysm surgery evoked a 70-80% dilatation of pial arteries, solvent-treated arteries dilated between 5 and 40%. In a multicenter study on 120 patients with preventive nimodipine treatment and acute operation of ruptured aneurysms, the incidence of delayed cerebral ischemia and fixed neurologic deficit was 1.7%. It is concluded that acute surgery of ruptured cerebral aneurysms and treatment with the calcium antagonist nimodipine substantially reduce the risk of symptomatic vasospasm.
D000818:Animals; D001158:Arteries / Q000187:drug effects; D002545:Brain Ischemia / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002415:Cats; D002548:Cerebral Revascularization; D002986:Clinical Trials as Topic; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D009539:Nicotinic Acids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D009553:Nimodipine; D010841:Pia Mater / Q000098:blood supply; D011183:Postoperative Complications / Q000517:prevention & control; D013345:Subarachnoid Hemorrhage / Q000628:therapy*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D002121:Calcium Channel Blockers; D009539:Nicotinic Acids; D014665:Vasodilator Agents; D009553:Nimodipine