title: Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results.
abstract: OBJECTIVE
  Cerebral vasospasm remains a major problem in patients recovering from aneurysmal subarachnoid hemorrhage despite advances in medical, surgical, and endovascular care. Our purpose was to assess the efficacy of intra-arterial nimodipine, a calcium-channel blocker acting mainly on cerebral vessels, in preventing delayed neurologic deficits in patients with symptomatic vasospasm.
  
  
  METHODS
  Clinical charts of 25 consecutively treated patients were retrospectively reviewed. A multifactorial decision tree was used to determine the indication for angiography and subsequent endovascular treatment. Nimodipine was infused intra-arterially via a diagnostic catheter in the internal carotid artery or vertebral artery at a rate of 0.1 mg/min. Angiographic vasospasm before endovascular treatment, immediate vessel caliber modifications, and short- and long-term clinical efficacy of the procedure were assessed.
  
  
  RESULTS
  Thirty procedures were performed in 25 patients. Clinical improvement was observed in 19 (76%), 16 of whom improved after the first endovascular procedure, two after the second intra-arterial treatment, and one after the third. Of these 19 patients, only 12 (63%) had notable vascular dilatation at postprocedural angiography. Dilatation of infused vessels occurred in only 13 (43%) of 30 procedures. After follow-up of 3-6 months, 18 (72%) of 25 patients had a favorable outcome (Glasgow outcome scale score of 1-2 and modified Rankin scale score of 0-2). No complications were observed.
  
  
  CONCLUSIONS
  Intra-arterial nimodipine is effective and safe for the treatment of symptomatic vasospasm after subarachnoid hemorrhage. Further prospective randomized studies of cerebral blood flow are needed to confirm these results.
authors.affiliation: Department of Neuroradiology, Pitie-Salpetriere Hospital-Paris VI University, Paris, France.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Biondi
authors.forename: Giuseppe K
authors.initials: GK
authors.lastname: Ricciardi
authors.forename: Louis
authors.initials: L
authors.lastname: Puybasset
authors.forename: Lamine
authors.initials: L
authors.lastname: Abdennour
authors.forename: Marcello
authors.initials: M
authors.lastname: Longo
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
authors.forename: Rémy
authors.initials: R
authors.lastname: Van Effenterre
mesh_terms: D000328:Adult; D000792:Angiography; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology
chemical_list: D002121:Calcium Channel Blockers; D009553:Nimodipine