title: Continuous intra-arterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a feasibility study and outcome results.
abstract: BACKGROUND
  Severe cerebral vasospasm is a major cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. No causative treatment is yet available and hypertensive hypervolemic therapy (HHT) is often insufficient to avoid delayed cerebral ischemia and neurological deficits. We compared patients receiving continuous intra-arterial infusion of the calcium-antagonist nimodipine with a historical group treated with HHT and oral nimodipine alone.
  
  
  METHODS
  Between 0.5 and 1.2 mg/h of nimodipine were continuously administered by intra-arterial infusion via microcatheters either into the internal carotid or vertebral artery or both, depending on the areas of vasospasm. The effect was controlled via multimodal neuromonitoring and transcranial Doppler sonography. Outcome was determined by means of the Glasgow Outcome Scale at discharge and 6 months after the hemorrhage and compared to a historical control group.
  
  
  RESULTS
  Twenty-one patients received 28 intra-arterial nimodipine infusions. Six months after discharge, the occurrence of cerebral infarctions was significantly lower (42.6 %) in the nimodipine group than in the control group (75.0 %). This result was reflected by a significantly higher proportion (76.0 %) of patients with good outcome in the nimodipine-treated group, when compared to 10.0 % good outcome in the control group. Median GOS was 4 in the nimodipine group and 2 in the control group (p = 0.001).
  
  
  CONCLUSIONS
  Continuous intra-arterial nimodipine infusion is an effective treatment for patients with severe cerebral vasospasm who fail to respond to HHT and oral nimodipine alone. Key to the effective administration of continuous intra-arterial nimodipine is multimodal neuromonitoring and the individual adaptation of dosage and time of infusion for each patient.
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. sylvia.bele@ukr.de.
authors.forename: Sylvia
authors.identifier: http://orcid.org/0000-0001-9887-3165
authors.initials: S
authors.lastname: Bele
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. martin.proescholdt@ukr.de.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Proescholdt
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. andreas.hochreiter@ukr.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochreiter
authors.affiliation: Department of Neuroradiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. institut-nro-r@medbo.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuierer
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. judith.scheitzach@ukr.de.
authors.forename: Judith
authors.initials: J
authors.lastname: Scheitzach
authors.affiliation: Department of Neuroradiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. christina.wendl@ukr.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Wendl
authors.affiliation: Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. martin.kieninger@ukr.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Kieninger
authors.affiliation: Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. andre.schneiker@ukr.de.
authors.forename: Andre
authors.initials: A
authors.lastname: Schneiker
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. elisabeth.bruendl@ukr.de.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bründl
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. petra.schoedel@ukr.de.
authors.forename: Petra
authors.initials: P
authors.lastname: Schödel
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. karl-michael.schebesch@ukr.de.
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Schebesch
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany. alexander.brawanski@ukr.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
mesh_terms: D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage* / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology
chemical_list: D002121:Calcium Channel Blockers; D009553:Nimodipine
keywords: Cerebral vasospasm (CV); Continuous intra-arterial nimodipine infusion (CIAN); Improved outcome; Subarachnoid hemorrhage