Anthofer, Judith and Bele, Sylvia and Wendl, Christina and Kieninger, Martin and Zeman, Florian and Bruendl, Elisabeth and Schmidt, Nils-Ole and Schebesch, Karl-Michael (2022) Continuous intra-arterial nimodipine infusion as rescue treatment of severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage. JOURNAL OF CLINICAL NEUROSCIENCE, 96. pp. 163-171. ISSN 0967-5868, 1532-2653
Full text not available from this repository. (Request a copy)Abstract
Severe refractory cerebral vasospasm (CV) is a major cause of disability and death in patients with aneurysmal subarachnoid hemorrhage (SAH). One rescue therapy in selected patients is intra-arterial nimodipine, either given as a single shot or as continuous infusion. To evaluate treatment efficacy, we analyzed outcome factors such as the incidence of craniectomy, ventriculo-peritonial (VP) shunting, and tracheotomy after intra-arterial nimodipine infusion. We retrospectively analyzed the rates of cerebral infarction, decompressive craniectomy, VP shunting, and tracheotomy in patients with severe CV after SAH. Three different patient groups were compared: group 1 had only been treated with oral nimodipine and hypervolemic hypertensive therapy (HHT) (2006-2010), group 2 with a single shot of intra-arterial nimodipine (SSN) in addition to oral conservative treatment (2006-2010), and group 3 with continuous intra-arterial nimodipine (CIAN) (2011-2017). The incidence of cerebral infarction was significantly lower in CIAN group (p = 0.005) than in conservative and SSN group. The indication for consecutive decompressive craniectomy was significantly lower in CIAN group in comparison with the conservative group (p = 0.018). The rates of VP shunting and tracheotomy were significantly higher in the CIAN group than in the conservative group (p = 0.028 for VP, and p = 0.003 for tracheotomy). The significantly lower rate of craniectomy in the CIAN group was most probably attributable to the significantly lower rate of CV-induced infarction. The higher rate of tracheotomy reflects more extensive sedation and the need of longer stays on the intensive care unit. Thus, the effect on long-term neurological outcome and quality of life has to be evaluated separately. (c) 2021 Elsevier Ltd. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DECOMPRESSIVE HEMICRANIECTOMY; CLINICAL-COURSE; MANAGEMENT; PAPAVERINE; EXPERIENCE; INJECTION; ISCHEMIA; THERAPY; Continuous intra-arterial nimodipine; infusion (CIAN); Intra-arterial nimodipine infusion; Cerebral vasospasm; subarachnoid hemorrhage (SAH); delayed cerebral ischemia (DCI); Outcome |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Lehrstuhl für Neurochirurgie Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Klinische Studien Medicine > Zentrum für Neuroradiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 05 Dec 2023 14:11 |
| Last Modified: | 05 Dec 2023 14:11 |
| URI: | https://pred.uni-regensburg.de/id/eprint/56931 |
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