Intra-Arterial Nimodipine for the Treatment of Symptomatic Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Preliminary Results
Alessandra Biondia,
Giuseppe K. Ricciardia,
Louis Puybassetb,
Lamine Abdennourb,
Marcello Longod,
Jacques Chirasa and
Rémy Van Effenterrec
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
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FIG 1. Case 25. This patient presented with a decreased level of consciousness and was treated with intra-arterial nimodipine for symptomatic cerebral vasospasm following SAH.
A and B, Anteroposterior (A) and lateral (B) angiograms of the left internal carotid artery show vasospasm at the level of the carotid siphon, the terminal internal carotid artery, the A1 segment of the ACA, and the MCA.
C and D, Anteroposterior (C) and lateral (D) angiograms obtained after intra-arterial injection of nimodipine 3 mg into the internal carotid artery demonstrate an increased diameter of the vessels. The patient’s clinical condition rapidly improved after treatment.
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FIG 2. Case 4. This patient with right hemiparesis was treated with intra-arterial nimodipine for symptomatic cerebral vasospasm following SAH. This patient had moderate vasospasm of tICA, ACA and MCA on the left side.
A, Lateral angiogram of the left internal carotid artery shows vasospasm involving also the distal cerebral branches (arrows).
B, Lateral angiogram of the left internal carotid artery obtained after the intra-arterial injection of nimodipine 2 mg shows a slight increase in the size of the distal arteries (arrows) and the internal carotid system. Despite the poor angiographic results, the patient’s condition improved significantly within 12 hours, and no recurrence of symptoms was observed.
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FIG 3. Case 12. Patient presenting with left hemiparesis and diffuse and severe vasospasm. After an intra-arterial injection of 3 mg of nimodipine into both carotid arteries and the basilar artery, angiographic and clinical results were poor. A second session with injection of 5 mg of nimodipine into the same vessels achieved good angiographic results and clinical improvement.
A, This angiogram obtained before the intra-arterial injection of nimodipine shows a moderate vasospasm of the left vertebral artery. (Vasospasm was severe in the other vessels, not shown.)
B, After nimodipine therapy, this left vertebral artery angiogram shows increased size of the basilar artery. Despite these results, the patient later died from cardiopulmonary complications.
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