Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage.
BACKGROUND
Delayed ischemic neurological deficit associated to cerebral vasospasm is the most common cause of sequelae and death that follows the rupture of an aneurysm. The objective of this study was to evaluate the safety and efficacy of intra-arterial Milrinone in patients with symptomatic refractory cerebral vasospasm.


METHODS
Eight patients diagnosed with aneurysmal subarachnoid hemorrhage who developed symptomatic cerebral vasospasm refractory to conventional medical therapy were enrolled. They received an intra-arterial infusion of Milrinone at a rate of 0.25 mg/min, with a total dose of 10-15 mg. Qualitative evaluation of angiographic response, neurological and systemic complications as well as functional outcome at 3 months were documented.


RESULTS
All patients had a significant angiographic response. This was evidenced by a pre-treatment vessel stenosis greater than 70%, that improved to less than 50% after the intra-arterial Milrinone infusion. Three patients developed recurrent vasospasm that improved after a second intra-arterial Milrinone infusion. None of the patients developed neurologic or systemic complications attributed to the intervention. At 3 months follow-up all patients were alive and had a mean modified Rankin scale of 2 +/- 1 and a Barthel index of 83 +/- 10.


CONCLUSIONS
Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Romero
C M
CM
Critical Patient Unit, Department of Medicine, Clinical Hospital, University of Chile, Santiago Norte, Chile. caromero@redclinicauchile.cl
Morales
D
D
Reccius
A
A
Mena
F
F
Prieto
J
J
Bustos
P
P
Larrondo
J
J
Castro
J
J
D000328:Adult; D001794:Blood Pressure; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy; D002533:Cerebral Angiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D007261:Infusions, Intra-Arterial; D002532:Intracranial Aneurysm / Q000188:drug therapy*; D007427:Intracranial Pressure / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012449:Safety; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
D010975:Platelet Aggregation Inhibitors; D020105:Milrinone