gms | German Medical Science

Objective: To evaluate the effectivness of selective intraarterial nimodipine admini-stration in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Method: 23 consecutive patients (6 male, 17 female, 22 to 77 years old) with severe medically refractory cerebral vasospasm were treated. A multifactorial decision tree was used to determine the indication for digital substraction angiography and selective intraarterial nimodipine application in a standardized regimen (2 mg nimodipine diluted with 20 ml 0,9 % NaCl and an infusion rate of 1 ml/min). Effectiveness was prospectively rated regarding vessel caliber modifications and neurological course.

Results: Totally, 46 vessel territories (39 in the anterior circulation, 7 in the posterior circulation) in the 23 patients were endovascularly infused with nimodipine. An angiographic effect was observed in 22 of 23 (95,6%) patients. In 7 (31,8%) patients the effect was good (remarkable enlargement in vessel caliber) and moderate (minor vessel caliber improvement) in 15 patients (68, 2%). In one patient there was no effect. Clinically, in 11 patients (47,8 %) neurologic deficits ameliorated, in 12 patients (52,2%) no improvement of neurologic status was observed. Four patients (17,4%) died due to vasospasm related multiple infarctions. In two patients (8,7%) a decrease of blood pressure was noticed during intraarterial administration of nimodipine. No severe adverse effects were noted.

Conclusions: Selective intraarterial nimodipine application in severe cerebral vasospasm should be considered a therapeutical option in selected cases.