gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

The effectiveness of intraarterial endovascular treatment of macrovasospasm in patients with subarachnoid hemorrhage

Meeting Abstract

  • Christian von der Brelie - Department of Neurosurgery, University Hospital Schleswig- Holstein, Campus Kiel, Kiel, Germany
  • Alexandros Doukas - Department of Neurosurgery, University Hospital Schleswig- Holstein, Campus Kiel, Kiel, Germany
  • Naomi Larsen - Department of Radiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • Maximilian Mehdorn - Department of Neurosurgery, University Hospital Schleswig- Holstein, Campus Kiel, Kiel, Germany
  • Michael Synowitz - Department of Neurosurgery, University Hospital Schleswig- Holstein, Campus Kiel, Kiel, Germany
  • Olav Jansen - Department of Radiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.09.03

doi: 10.3205/16dgnc034, urn:nbn:de:0183-16dgnc0340

Veröffentlicht: 8. Juni 2016

© 2016 von der Brelie et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: In subarachnoid hemorrhage (SAH) macrovasospasm is one of the major reasons for clinical worsening. Treatment via intraarterial administration of Nimodipine and / or angioplasty might be a therapeutic option. The aim of this study was to compare different forms of intraarterial treatment with regard to their efficacy, safety and clinical outcome.

Method: A retrospective observational analysis was performed. Patients were treated between 2005 and 2015. Inclusion criteria were aneurysmal SAH, clinical and or / radiological evidence of vasospasm or evidence of tissue at risk in the perfusion CT and interventional intraarterial treatment. The number of intraarterial treatments was noted. Patients were divided in 3 groups: continuous Nimodipine infusion, repetitive Nimodipine infusions and singular treatment. Postinterventional parameters (TCD and ptiO2) were checked to analyze the efficacy of the procedure and the decision making. Outcome was analyzed using the mRs.

Results: 168 interventions were performed in 98 patients. 15 patients were assigned to the group of continuous intraarterial treatment, 16 patients underwent repetitive intraarterial treatment and 67 patients underwent singular treatment. Baseline characteristics were not different in the groups. Patients in the continuous group had undergone coiling significantly more often compared to the repetitive treatment group. (p = 0.004). In the repetitive group, postinterventional TCD values decreased significantly more often (93%; versus 53% in the continuous treatment group; p = 0.007). Ptio2 values also increased more often. Nonetheless this result was not statistically significant. Short-term outcome was significantly different, outcome was worse in the patients who underwent continuous intraarterial Nimodipine treatment (p = 0.01). Complication rate in patients with continuous intraarterial Nimodipine treatment was 33%, half of which was assigned to be procedural related complications.

Conclusions: Patients in the continuous group had undergone coiling significantly more often reflecting a reduced vessel reaction to Nimodipine treatment. Postinterventional TCD values showed decreasing flow velocities significantly less often in cases with continuous administration of Nimodipine indicating a less efficient procedure. Neurological outcome in the continuous Nimodipine group was worse most probably due to the comparatively more severe forms of DCI. The high complication rate shows that the procedure itself is highly demanding.

Note: Christian von der Brelie and Alexandros Doukas contributed equally.