title: Effect of intrathecal milrinone injection via lumbar catheter on delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE Delayed cerebral ischemia (DCI) is an important complication after aneurysmal subarachnoid hemorrhage (aSAH). Although intrathecal milrinone injection via lumbar catheter to prevent DCI has been previously reported to be safe and feasible, its effectiveness remains unknown. The goal of this study was to evaluate whether intrathecal milrinone injection treatment after aSAH significantly reduced the incidence of DCI. METHODS The prospectively maintained aSAH database was used to identify patients treated between January 2010 and December 2015. The cohort included 274 patients, with group assignment based on treatment with intrathecal milrinone injection or not. A propensity score model was generated for each patient group, incorporating relevant patient variables. RESULTS After propensity score matching, 99 patients treated with intrathecal milrinone injection and 99 without treatment were matched on the basis of similarities in their demographic and clinical characteristics. There were significantly fewer DCI events (4% vs 14%, p = 0.024) in patients treated with intrathecal milrinone injection compared with those treated without it. However, there were no significant differences between the 2 groups with respect to their 90-day functional outcomes (46% vs 36%, p = 0.31). The likelihood of chronic secondary hydrocephalus, meningitis, and congestive heart failure as complications of intrathecal milrinone injection therapy was also similar between the groups. CONCLUSIONS In propensity score-matched groups, the intrathecal administration of milrinone via lumbar catheter showed significant reduction of DCI following aSAH, without an associated increase in complications.
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Koyanagi
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: 2Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec,Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lo
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Minami
authors.initials: M
authors.lastname: Uezato
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurosaki
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Nobutake
authors.initials: N
authors.lastname: Sadamasa
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Akira
authors.initials: A
authors.lastname: Handa
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Masaki
authors.initials: M
authors.lastname: Chin
authors.affiliation: 1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D057785:Catheters; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage* / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control*
chemical_list: D014665:Vasodilator Agents; D020105:Milrinone
keywords: ACA = anterior cerebral artery; DCI = delayed cerebral ischemia; DIND = delayed ischemic neurological deficit; IQR = interquartile range; WFNS = World Federation of Neurosurgical Societies; aSAH = aneurysmal subarachnoid hemorrhage; intrathecal milrinone; mRS = modified Rankin Scale; propensity score; subarachnoid hemorrhage; vascular disorders; vasospasm