title: Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: Influence on clinical course and predictors of clinical outcome.
abstract: Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course.
authors.affiliation: Department of Neurosurgery, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark ab@asmabashir.com.
authors.forename: Asma
authors.initials: A
authors.lastname: Bashir
authors.affiliation: Department of Neurosurgery, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Andresen
authors.affiliation: Department of Neurosurgery, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jiri
authors.initials: J
authors.lastname: Bartek
authors.affiliation: Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Cortsen
authors.affiliation: Department of Neurosurgery, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Vagn
authors.initials: V
authors.lastname: Eskesen
authors.affiliation: Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Aase
authors.initials: A
authors.lastname: Wagner
mesh_terms: D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage*; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology
chemical_list: D014665:Vasodilator Agents; D009553:Nimodipine
keywords: Subarachnoid haemorrhage; cerebral vasospasm; intra-arterial nimodipine
references.citation: J Neurosurg. 1991 Jun;74(6):985-90
references.pmid: 1827838
references.citation: J Korean Neurosurg Soc. 2012 Sep;52(3):172-8
references.pmid: 23115657
references.citation: J Neurosurg. 1995 Sep;83(3):430-4
references.pmid: 7666218
references.citation: Stroke. 2012 Jun;43(6):1711-37
references.pmid: 22556195
references.citation: Clin Radiol. 2005 Sep;60(9):1030-6
references.pmid: 16124986
references.citation: Neuroscience. 1993 Apr;53(3):837-44
references.pmid: 8487958
references.citation: Br J Anaesth. 2013 Apr;110(4):577-85
references.pmid: 23257989
references.citation: J Cereb Blood Flow Metab. 1986 Jun;6(3):321-31
references.pmid: 3711159
references.citation: AJNR Am J Neuroradiol. 2007 May;28(5):844-8
references.pmid: 17494654
references.citation: Neurosurgery. 1999 Jun;44(6):1237-47; discussion 1247-8
references.pmid: 10371622
references.citation: Interv Neuroradiol. 2011 Jun;17 (2):169-78
references.pmid: 21696654
references.citation: Stroke. 1987 Jan-Feb;18(1):210-6
references.pmid: 3810755
references.citation: Br J Neurosurg. 2012 Aug;26(4):517-24
references.pmid: 22303863
references.citation: Stroke. 1985 Jul-Aug;16(4):562-72
references.pmid: 3895589
references.citation: Stroke. 2007 Mar;38(3):1091-6
references.pmid: 17272767
references.citation: Stroke. 2001 Oct;32(10):2292-8
references.pmid: 11588316
references.citation: Neurocrit Care. 2010 Jun;12(3):346-51
references.pmid: 20033353
references.citation: J Korean Neurosurg Soc. 2009 Sep;46(3):239-44
references.pmid: 19844625
references.citation: Stroke. 2001 Sep;32(9):2012-20
references.pmid: 11546890
references.citation: Stroke. 2008 Mar;39(3):893-8
references.pmid: 18239182
references.citation: Neurosurgery. 2008 Dec;63(6):1080-6; discussion 1086-7
references.pmid: 19057319
references.citation: AJNR Am J Neuroradiol. 1995 Jan;16(1):27-38
references.pmid: 7900600
references.citation: Vasc Endovascular Surg. 2012 Aug;46(6):460-5
references.pmid: 22914892
references.citation: J Neurosurg. 1995 Sep;83(3):435-7
references.pmid: 7666219
references.citation: J Neurosurg. 2003 May;98(5):978-84
references.pmid: 12744357
references.citation: J Neurosurg. 2008 Mar;108(3):458-63
references.pmid: 18312091
references.citation: J Neurosurg. 1996 Mar;84(3):405-14
references.pmid: 8609551
references.citation: J Neurosurg. 1984 Aug;61(2):231-40
references.pmid: 6737047
references.citation: J Neurosurg. 1988 Jun;68(6):985-6
references.pmid: 3131498
references.citation: AJNR Am J Neuroradiol. 2004 Jun-Jul;25(6):1067-76
references.pmid: 15205150
references.citation: Neurocrit Care. 2011 Sep;15(2):312-7
references.pmid: 21748499
references.citation: J Neurosurg. 1996 Apr;84(4):690-5
references.pmid: 8613866
references.citation: Continuum (Minneap Minn). 2012 Jun;18(3):579-97
references.pmid: 22810250
references.citation: Neurol Res Int. 2013;2013:415960
references.pmid: 23476766
references.citation: Neurosurgery. 2001 Feb;48(2):249-61; discussion 261-2
references.pmid: 11220367
references.citation: J Neurosurg. 1999 Jul;91(1):51-8
references.pmid: 10389880
references.citation: Neurol India. 2011 Nov-Dec;59(6):810-6
references.pmid: 22234190
references.citation: AJNR Am J Neuroradiol. 2008 Jun;29(6):1053-60
references.pmid: 18372422