American Journal of Neuroradiology 25:1067-1076, June-July 2004
© 2004 American Society of Neuroradiology
INTERVENTIONAL
Intra-Arterial Nimodipine for the Treatment of Symptomatic Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Preliminary Results
a Department of Neuroradiology, Pitié-Salpêtrière Hospital–Paris VI University, Paris, France
b Department of Anesthesiology, Pitié-Salpêtrière Hospital–Paris VI University, Paris, France
c Department of Neurosurgery, Pitié-Salpêtrière Hospital–Paris VI University, Paris, France
d Department of Radiology, University of Messina, Italy
Address reprint requests to Alessandra Biondi, MD, Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, 47/83 Boulevard de l’Hôpital, 75651 Paris, Cedex 13, France
BACKGROUND AND PURPOSE: Cerebral vasospasm remains a major problem in patients recovering from aneurysmal subarachnoid hemorrhage despite advances in medical, surgical, and endovascular care. Our purpose was to assess the efficacy of intra-arterial nimodipine, a calcium-channel blocker acting mainly on cerebral vessels, in preventing delayed neurologic deficits in patients with symptomatic vasospasm.
METHODS: Clinical charts of 25 consecutively treated patients were retrospectively reviewed. A multifactorial decision tree was used to determine the indication for angiography and subsequent endovascular treatment. Nimodipine was infused intra-arterially via a diagnostic catheter in the internal carotid artery or vertebral artery at a rate of 0.1 mg/min. Angiographic vasospasm before endovascular treatment, immediate vessel caliber modifications, and short- and long-term clinical efficacy of the procedure were assessed.
RESULTS: Thirty procedures were performed in 25 patients. Clinical improvement was observed in 19 (76%), 16 of whom improved after the first endovascular procedure, two after the second intra-arterial treatment, and one after the third. Of these 19 patients, only 12 (63%) had notable vascular dilatation at postprocedural angiography. Dilatation of infused vessels occurred in only 13 (43%) of 30 procedures. After follow-up of 3–6 months, 18 (72%) of 25 patients had a favorable outcome (Glasgow outcome scale score of 1–2 and modified Rankin scale score of 0–2). No complications were observed.
CONCLUSION: Intra-arterial nimodipine is effective and safe for the treatment of symptomatic vasospasm after subarachnoid hemorrhage. Further prospective randomized studies of cerebral blood flow are needed to confirm these results.