gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Continuous selective intraarterial infusion of nimodipine for therapy of refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Kontinuierliche Gabe von intraarteriellem Nimodipin zur Therapie des refraktären zerebralen Vasospasmus nach aneurysmatischer Subarachnoidalblutung

Meeting Abstract

  • corresponding author H. Stegmaier - Klinik für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen, Technische Universität München, München
  • J. F. Landscheidt - Klinik für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen, Technische Universität München, München
  • S. O. Rodiek - Klinik für Radiologie, Akademisches Lehrkrankenhaus München-Bogenhausen, Technische Universität München, München
  • S. Wolf - Klinik für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen, Technische Universität München, München
  • L. Schürer - Klinik für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen, Technische Universität München, München
  • C. B. Lumenta - Klinik für Neurochirurgie, Akademisches Lehrkrankenhaus München-Bogenhausen, Technische Universität München, München

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.01.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc006.shtml

Veröffentlicht: 11. April 2007

© 2007 Stegmaier et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: For treatment of vasospasm after aneurysmal subarachnoid hemorrhage (aSAH), a variety of selective endovascular treatment options exist, including balloon dilatation, stenting, and infusion of a cerebral vasodilator. For the latter, especially nimodipine was proposed for selective intraarterial administration up to 30 minutes in the affected vessel under angiographic control [1]. As some patients still showed ongoing vasospasm after this treatment, we report on our experience with an extended time period of selective intraarterial nimodipine administration on the Neurosurgical ICU.

Methods: In six patients with aSAH and cerebral vasospasm refractory to standard hyperdynamic therapy and endovascular techniques, we left the catheter in situ in the internal carotid artery after angiographic verification of severe ongoing vasospasm. On the ICU, a continuous infusion of intraarterial nimodipine was commenced, combined with intraarterial heparin anticoagulation. The effectiveness of this therapy was controlled using TCD, brain tissue oxygenation and regional CBF probes placed in the tissue-at-risk for vasospasm induced infarction as well as perfusion CCT scans on a frequent base. Repeat angiography was performed on clinical demand, the latest after 48 hours of continuous nimodipine treatment.

Results: Two of the six patients died from refractory vasospasm and consecutive multiple cerebral infarctions and a third suffered lethal sepsis after initially successful continuous intraarterial nimodipine therapy. Three patients survived in a good clinical condition, one of them without apparent neurologic deficit. The effectiveness of intraarterial nimodipine was best verified with regional CBF monitoring, while TCD failed to detect vasospasm in one patient and improvement in two others. Brain tissue oxygenation increased in all patients, but failed to detect vasospasm in one patient despite proper probe placement. CBF measured by perfusion CCT improved in all patients; however, absolute values were not sensitive for vasospasm diagnosis.

Conclusions: Selective continuous intraarterial nimodipine treatment for refractory cerebral vasospasm after aSAH seems feasible and may add to the endovascular armamentarium. From our experience, an appropriate amount of intensive care monitoring technology seems paramount for further investigation to ensure efficacy and safety of this novel technique.


References

1.
Biondi A, et al. Intra-Arterial Nimodipine for the Treatment of Symptomatic Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Preliminary Results. AJNR. 2004;25:1067–76.