title: Continuous local intra-arterial nimodipine administration in severe symptomatic vasospasm after subarachnoid hemorrhage.
abstract: BACKGROUND
  Cerebral vasospasm (CV) is a potentially disastrous consequence of subarachnoid hemorrhage despite medical treatment. Nimodipine is a potent drug for vessel relaxation, but side effects may preclude a sufficient dose.
  
  
  OBJECTIVE
  To explore whether continuous local intra-arterial nimodipine administration (CLINA) can reverse vasospasm and prevent delayed ischemic neurological deficit.
  
  
  METHODS
  Six consecutive subarachnoid hemorrhage patients (5 women; mean age, 47.2 years) with severe CV despite maximum medical therapy underwent CLINA within 2 hours after the onset of clinical symptoms. After anticoagulation, microcatheters were inserted distally in the concerning supra-aortic vessels. Glyceryl trinitrate injection (2 mg) was followed by CLINA (nimodipine 0.4 mg/h for 70-147 hours). Duration of CLINA was determined by neurological status, transcranial Doppler sonography, and partial tissue oxygen pressure values.
  
  
  RESULTS
  In all patients, neurological deficits improved or partial tissue oxygen pressure values returned to normal and transcranial Doppler sonography confirmed a reduced blood flow velocity within 12 hours. Magnetic resonance imaging showed no ischemic lesion caused by CV. Neurological outcome was good (modified Rankin Scale score, 0-2) in 3 patients, whereas 1 patient had a moderate clinical outcome (modified Rankin Scale score, 3-4) and 2 patients had a poor outcome (modified Rankin Scale score, 5) because of the SAH.
  
  
  CONCLUSIONS
  Preliminary data show that CLINA is a straightforward, effective, and safe option for patients with severe CV refractory to medical therapy. Dilation of spastic arteries starts within a few hours and is lasting. Indication for CLINA is peripheral and diffuse CV at any location.
authors.affiliation: Department of Neurosurgery, Klinikum Stuttgart, Germany. c.musahl@klinikum-stuttgart.de
authors.forename: Christian
authors.initials: C
authors.lastname: Musahl
authors.forename: Hans
authors.initials: H
authors.lastname: Henkes
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Vajda
authors.forename: Jan
authors.initials: J
authors.lastname: Coburger
authors.forename: Nikolai
authors.initials: N
authors.lastname: Hopf
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000187:drug effects*; 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*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology
chemical_list: D014665:Vasodilator Agents; D009553:Nimodipine