title: Milrinone via lumbar subarachnoid catheter for vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Delayed ischemic neurological deficit (DIND) due to symptomatic vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to elucidate the safety and feasibility of intrathecal milrinone infusion via lumber subarachnoid catheter for prevention of DIND after aSAH.
  
  
  METHODS
  We diagnosed 425 consecutive patients with aSAH who received clipping or coil embolization within 48 h after arrival. Patients with the evidence of vasospasm on CT angiography (CTA) received the milrinone therapy via lumbar subarachnoid catheter. DIND, delayed cerebral infarction (DCI), and modified Rankin scale at 3 months after SAH were used for the assessment of outcome.
  
  
  RESULTS
  Of 425 patients, 170 patients (40.0 %) with CTA-proven vasospasm received the milrinone therapy. DIND was observed in 68 patients (16.0 %), DCI in 30 patients (7.1 %), and the overall mortality was 7.2 %. In patients with WFNS grade IV and V aSAH, 26 out of 145 patients (17.9 %) were presented with DIND, 12 (8.3 %) with DCI, and the mortality was 16.0 %. No major complication related to the milrinone injection was observed.
  
  
  CONCLUSIONS
  Intrathecal milrinone injection via lumbar catheter was safe and feasible, and further randomized prospective studies are needed to confirm the effectiveness of this regimen in the patients with SAH.
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki City, Okayama, 710-8602, Japan, nobutak@gmail.com.
authors.forename: Nobutake
authors.initials: N
authors.lastname: Sadamasa
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Osamu
authors.initials: O
authors.lastname: Narumi
authors.forename: Masaki
authors.initials: M
authors.lastname: Chin
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000517:prevention & control*; D005260:Female; D006801:Humans; D060186:Infusions, Spinal; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*
chemical_list: D014665:Vasodilator Agents; D020105:Milrinone