Yıl 2020, Cilt 10 , Sayı 2, Sayfalar 213 - 219 2020-06-25

Efficacy of intra-arterial nimodipine therapy in the treatment of vasospasm after subarachnoid hemorrhage

Vedat AÇIK [1]

Background: This study aims to investigate the efficacy of intra-arterial nimodipine therapy in treating patients that presented with spontaneous subarachnoid hemorrhage and developed vasospasm following aneurysm surgery. Methods: The study includes 37 patients that underwent intra-arterial nimodipine therapy for the treatment of cerebral vasospasm between October 2015 and December 2019. In patients that developed vasospasm, a catheter was selectively inserted into the internal carotid artery, 1–2 mg of nimodipine was diluted with 50 ccs of saline, and was slowly infused through the catheter. Results: In our study, we found the success rate of intra-arterial nimodipine administration to be 78.4% (neurologic findings completely improved in 29 cases). The clinical condition did not improve in 13.5% of cases and worsened in 8.1%. 86.4% of our patients were discharged with good outcomes (mRS score 0–1). Conclusion: We conclude that intra-arterial nimodipine therapy is a cost-effective, safe, and successful method for the treatment of cerebral vasospasm, a condition that directly affects morbidity and mortality after subarachnoid hemorrhage. Prospective studies are needed to determine standard doses and application times in order to establish the efficacy of intra-arterial nimodipine therapy in treating cerebral vasospasm.
spontaneous subarachnoid hemorrhage
  • References 1. San-Juan, D., M.A. Zenteno, D. Trinidad, et al., A Pilot Study of Facial Nerve Stimulation on Cerebral Artery Vasospasm in Subarachnoid Hemorrhage Patients. IEEE Journal of Translational Engineering in Health and Medicine, 2019. 7: p. 1-7. 2. Bahadir, S., F. Narin, I. Başar, Ş. Hanalioğlu, B. Bilginer, and N. Akalan, The effect of pentoxifylline on cerebral vasospasm following experimental subarachnoid hemorrhage. International Journal of Neuroscience, 2020(just-accepted): p. 1-7. 3. Gross, B.A., P.M.R. Lai, K.U. Frerichs, and R. Du, Treatment modality and vasospasm after aneurysmal subarachnoid hemorrhage. World neurosurgery, 2014. 82(6): p. e725-e30. 4. Song, J.-N., J.-Y. An, G.-S. Hao, et al., Role of Akt signaling pathway in delayed cerebral vasospasm after subarachnoid hemorrhage in rats. Acta neurochirurgica, 2013. 155(11): p. 2063-70. 5. Ferguson, S. and R.L. Macdonald, Predictors of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery, 2007. 60(4): p. 658-67. 6. de Oliveira, J.G., J. Beck, C. Ulrich, J. Rathert, A. Raabe, and V. Seifert, Comparison between clipping and coiling on the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurgical review, 2007. 30(1): p. 22-31. 7. Macdonald, R.L., N.F. Kassell, S. Mayer, et al., Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1) randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke, 2008. 39(11): p. 3015-21. 8. Kazda, S. and R. Towart, Nimodipine: a new calcium antagonistic drug with a preferential cerebrovascular action. Acta neurochirurgica, 1982. 63(1-4): p. 259-65. 9. Towart, R., The selective inhibition of serotonin-induced contractions of rabbit cerebral vascular smooth muscle by calcium-antagonistic dihydropyridines. An investigation of the mechanism of action of nimodipine. Circulation research, 1981. 48(5): p. 650-7. 10. Kazda, S. and F. Hoffmeister. Effect of some cerebral vasodilators on the post-ischemic impaired cerebral reperfusion in cats. in NAUNYN-SCHMIEDEBERGS ARCHIVES OF PHARMACOLOGY. 1979. SPRINGER VERLAG 175 FIFTH AVE, NEW YORK, NY 10010. 11. Vatter, H., E. Güresir, J. Berkefeld, et al., Perfusion–diffusion mismatch in MRI to indicate endovascular treatment of cerebral vasospasm after subarachnoid haemorrhage. Journal of Neurology, Neurosurgery & Psychiatry, 2011. 82(8): p. 876-83. 12. Biondi, A., G.K. Ricciardi, L. Puybasset, et al., Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. American Journal of Neuroradiology, 2004. 25(6): p. 1067-76. 13. Garzon-Muvdi, T., G. Pradilla, J.J. Ruzevick, et al., A Glutamate Receptor Antagonist, S-4-Carboxyphenylglycine (S-4-CPG), Inhibits Vasospasm After Subarachnoid Hemorrhage in Haptoglobin 2 to 2 Mice. Neurosurgery, 2013. 73(4): p. 719-29. 14. Schebesch, K.-M., A. Herbst, S. Bele, et al., Calcitonin-gene related peptide and cerebral vasospasm. Journal of Clinical Neuroscience, 2013. 20(4): p. 584-6. 15. Sehba, F.A., A.Y. Schwartz, I. Chereshnev, and J.B. Bederson, Acute decrease in cerebral nitric oxide levels after subarachnoid hemorrhage. Journal of Cerebral Blood Flow & Metabolism, 2000. 20(3): p. 604-11. 16. Clatterbuck, R.E., P. Gailloud, T. Tierney, V.M. Clatterbuck, K.J. Murphy, and R.J. Tamargo, Controlled release of a nitric oxide donor for the prevention of delayed cerebral vasospasm following experimental subarachnoid hemorrhage in nonhuman primates. Journal of neurosurgery, 2005. 103(4): p. 745-51. 17. Pluta, R.M., Delayed cerebral vasospasm and nitric oxide: review, new hypothesis, and proposed treatment. Pharmacology & therapeutics, 2005. 105(1): p. 23-56. 18. Saber, H., A. Desai, M. Palla, W. Mohamed, N. Seraji-Bozorgzad, and M. Ibrahim, Efficacy of cilostazol in prevention of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a meta-analysis. Journal of Stroke and Cerebrovascular Diseases, 2018. 27(11): p. 2979-85. 19. Hänggi, D., B. Turowski, K. Beseoglu, M. Yong, and H. Steiger, Intra-arterial nimodipine for severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage: influence on clinical course and cerebral perfusion. American Journal of Neuroradiology, 2008. 29(6): p. 1053-60. 20. Hänggi, D., K. Beseoglu, B. Turowski, and H.-J. Steiger, Feasibility and safety of intrathecal nimodipine on posthaemorrhagic cerebral vasospasm refractory to medical and endovascular therapy. Clinical neurology and neurosurgery, 2008. 110(8): p. 784-90. 21. Musahl, C., H. Henkes, Z. Vajda, J. Coburger, and N. Hopf, Continuous local intra-arterial nimodipine administration in severe symptomatic vasospasm after subarachnoid hemorrhage. Neurosurgery, 2011. 68(6): p. 1541-7. 22. Onal, M.B., E. Civelek, A. Kircelli, et al., Comparison of nimodipine delivery routes in cerebral vasospasm after subarachnoid hemorrhage: an experimental study in rabbits, in Early Brain Injury or Cerebral Vasospasm. 2011, Springer. p. 23-8. 23. Roda, J.M., F. Carceller, E. Díez-Tejedor, and C. Avendaño, Reduction of infarct size by intra-arterial nimodipine administered at reperfusion in a rat model of partially reversible brain focal ischemia. Stroke, 1995. 26(10): p. 1888-92. 24. Böker, D.-K., L. Solymosi, and H. Wassmann, Immediate postangiographic intraarterial treatment of cerebral vasospasm after subarachnoid hemorrhage with nimodipine: report on 3 cases. Neurochirurgia, 1985. 28(S 1): p. 118-20. 25. Adami, D., J. Berkefeld, J. Platz, et al., Complication rate of intraarterial treatment of severe cerebral vasospasm after subarachnoid hemorrhage with nimodipine and percutaneous transluminal balloon angioplasty: Worth the risk? Journal of Neuroradiology, 2019. 46(1): p. 15-24.
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Orcid: 0000-0002-0371-5883
Yazar: Vedat AÇIK (Sorumlu Yazar)
Kurum: Adana Şehir Eğitim ve Araştırma Hastanesi
Ülke: Turkey

Teşekkür Dear Editor Enclosed, you will find our manuscript ‘‘Efficacy of intra-arterial nimodipine therapy in the treatment of vasospasm after subarachnoid hemorrhage‘’. Please consider it for publication as an ‘‘Original article’’ in the ‘‘Journal of Contemporary Medicine‘’ and let us know your criticisms. We hereby declare that all authors have made a substantial contribution to the information submitted for publication; all have read and approved the final manuscript and the manuscript or portions are not under consideration by another journal and have not been previously published. We have been guaranteed that the study originality We look forward for a positive outcome. Yours sincerely,

Kabul Tarihi : 11 Haziran 2020
Yayımlanma Tarihi : 25 Haziran 2020

AMA Açık V . Efficacy of intra-arterial nimodipine therapy in the treatment of vasospasm after subarachnoid hemorrhage. J Contemp Med. 2020; 10(2): 213-219.