title: Is intra arterial nimodipine really beneficial in vasospasm following aneurysmal subarachnoid haemorrhage?
abstract: Object/Background: Vasospasm is a common cause of mortality and morbidity following rupture of intracranial aneurysm. Hemodynamic therapy instituted in these patients in the past has been replaced by direct manipulation of the spastic vessels by angioplasty and intra-arterial infusion of vasodilators. However, no case control studies exist proving its superiority. The purpose of our study was to compare the efficacy of intra-arterial nimodipine (IAN) to that of hemodynamic therapy in patients with vasospasm following aSAH.
  
  
  METHODS
  Fifty-three patients who developed vasospasm following aSAH were included in the study. IAN was instilled in addition to hemodynamic therapy in 39 patients and 14 patients (who refused to give consent for IAN) were continued on hemodynamic therapy alone and served as controls. The response to IAN was studied on angiogram. The clinical response was assessed in both the groups at regular intervals. IAN was repeated if necessary. The outcome (GOS) at discharge and at 3 months after discharge was compared.
  
  
  RESULTS
  Thirty-six (92.3%) out of 39 patients showed immediate angiographic reversal of vasospasm.28 of them showed clinical response, of which only 11 had lasting response. 11(28.2%) of 39 patients who received IAN had a good outcome at discharge and 23(58.9%) had a favourable outcome at 3 months follow up. In those who received hemodynamic therapy alone, 4 out of 14(28.6%) patients had a good outcome at discharge and 8 (57.1%) a favourable outcome at 3 months.
  
  
  CONCLUSIONS
  Angiographic reversal of vasospasm is seen in majority of the patients following IAN. However, this does not necessarily translate into a long lasting clinical response. The final outcome in patients who received hemodynamic therapy is comparable to those who received additional IAN. IAN does not appear to provide a major added advantage over the conventional hemodynamic therapy.
authors.affiliation: a Department of Neurosurgery , PGIMER , Chandigarh , India ;
authors.forename: Rajeev
authors.initials: R
authors.lastname: Goel
authors.affiliation: a Department of Neurosurgery , PGIMER , Chandigarh , India ;
authors.forename: Ashish
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: a Department of Neurosurgery , PGIMER , Chandigarh , India ;
authors.forename: Pravin
authors.initials: P
authors.lastname: Salunke
authors.affiliation: b Department of Radiodiagnosis , PGIMER , Chandigarh , India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: a Department of Neurosurgery , PGIMER , Chandigarh , India ;
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chhabra
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D002532:Intracranial Aneurysm / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage* / 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 / Q000188:drug therapy*
chemical_list: D014665:Vasodilator Agents; D009553:Nimodipine
keywords: Aneurysmal subarachnoid haemorrhage; Glasgow Outcome Scale; hemodynamic therapy; intra-arterial nimodipine; outcome; vasospasm