Artikel
Changes in cerebral blood flow in patients with severe vasospasm during continuous intraarterial application of nimodipine via microcatheter
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Autoren
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S. Bele
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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G. Schuierer
- Klinik für Neuroradiologie, Universitätsklinikum Regensburg
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M. Kieninger
- Klinik für Anästhesiologie und Schmerztherapie, Universitätsklinikum Regensburg
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A. Brawanski
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Severe cerebral vasospasm often occurs after subarachnoid hemorrhage (sah) and remains a treatment challenge for neurointensivists around the world despite a large number of clinical multicenter trials. Intraarterial application of vasodilators appears to be promising but the short half life time of most drugs remains a problem and the benefits are still controversial. At our clinic the continuous application of nimodipine into the carotid artery via a microcatheter is used to treat severe cerebral vasospasm. We were interested in the dynamic of changes in cerebral blood flow (csf) during the intraarterial nimodipine application. Therefore we implanted a csf measurement device (Hemedex) and ptiO2 (Licox) before the angiography to have continuous values of csf before, during and after nimodipine application.
Methods: A total of 4 patients were included in this preliminary study and 6 measurements were taken since two patients received a second run of intraarterial nimodipine treatment. Each patient received a csf (Hemedex) and ptiO2 (Licox) measurement device before angiography to set baseline values and to see changes during the application. Microcatheters were placed either in the carotid artery of the side with the most prominent spasm or in both carotid arteries. A continuous application of 1 mg nimodipine/h with a flow of 30 ml/h was given for 2–3 days. During this time the patients were not moved and mean arterial blood pressure, ICP, O2 saturation; csf and ptiO2 were measured continuously.
Results: In each patient a significant increase in csf was seen as early as 2 minutes after starting the nimodipine application. The mean increase was around 40% and continued to rise for up to 30 min after infusion start. During the following hour csf decreased and reached a steady state. After removing the catheters two patients showed signs of vasospasm again after two days. Therefore another treatment period was started. All four patients showed good clinical results after 4 weeks and were transferred to rehabilitation.
Conclusions: This preliminary study clearly shows that continuous intraarterial application of nimodipine into the carotid artery via microcatheter is a safe and effective treatment of severe vasospasm after sah. The Hemedex system used in this study is a helpful tool to assess the effects of nimodipine and to guide the therapy on the neuro ICU.
