Prostacyclin treatment normalises the MCA flow velocity in nimodipine-resistant cerebral vasospasm after aneurysmal subarachnoid haemorrhage: a pilot study.
BACKGROUND
Cerebral vasospasm triggered by subarachnoid haemorrhage is one of the major causes of post-haemorrhage morbidity and mortality. Several treatment modalities have been proposed, and none of them are fully effective.


METHODS
In this study we treated five patients with prostacyclin suffering vasospasm after a ruptured aneurysm not responding to high i.v. doses of nimodipine. All patients were severely ill, unconscious and in need of intensive care.


RESULTS
A low dose of prostacyclin i.v. infusion for 72 h reversed the vasospasm as measured by transcranial Doppler technique. The mean MCA blood flow velocity decreased from 199 +/- 31 cm/s to 92 +/- 6 cm/s within 72 h after the start of the prostacyclin infusion.


CONCLUSIONS
We suggest that low-dose prostacyclin treatment, an old treatment strategy, can be a treatment option in patients with vasospasm not responding to ordinary measures.
Department of Neurosurgery, University Hospital, SE-901 85, Umeå, Sweden. Lars-Owe.Koskinen@neuro.umu.se
Lars-Owe D
LO
Koskinen
Magnus
M
Olivecrona
Marie
M
Rodling-Wahlström
Silvana
S
Naredi
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance / Q000502:physiology; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage; D010865:Pilot Projects; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D009553:Nimodipine; D011464:Epoprostenol