gms | German Medical Science

Objective: Selective intraarterial nimodipine administration is an established treatment option for patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). However, the safety in patients with additional unsecured unruptured intracranial aneurysms is unknown.

Methods: Analysis of a series of 97 patients treated with intraarterial nimodipine for severe medically refractory cerebral vasospasm according to a standardized regimen (2 mg nimodipine diluted with 20 ml 0,9 % NaCl and an infusion rate of 1 ml/min) after aSAH. The ruptured aneurysms were secured by clipping or coiling in all patients. 17 patients (17,5 %) were identified with a total of 21 coexisting unruptured unsecured intracranial aneurysms.

Results: There were 17 patients (3 men, 14 women with a mean age of 54,2 years, range 36-76 years). The unruptured unsecured intracranial aneurysms had a mean diameter of 3,6 mm (range 2-7 mm). The most frequent aneurysm locations were middle cerebral artery (8 aneurysms) and internal carotid artery (8 aneurysms). Two patients had multiple additional aneurysms (4 in one patient and 2 in the other). No aneurysm ruptured during therapy and no alteration of aneurysm configuration was radiologically observed. Furthermore, no other adverse effects were noted.

Conclusion: Selective intraarterial nimodipine application for treatment of severe cerebral vasospasm is safe in patients with coexisting small unsecured unruptured intracranial aneurysms.