Article
Efficiency of intra-arterial milrinone application in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage
Search Medline for
Authors
-
Christopher Wendel
- Klinikum Stuttgart, Katharinenhospital, Klinik für Neurochirurgie, Stuttgart, Deutschland
-
Oliver Ganslandt
- Klinikum Stuttgart, Katharinenhospital, Klinik für Neurochirurgie, Stuttgart, Deutschland
-
Jens Rachinger
- Klinikum Stuttgart, Katharinenhospital, Klinik für Neurochirurgie, Stuttgart, Deutschland
-
Hans Henkes
- Klinikum Stuttgart, Katharinenhospital, Klinik für Neurochirurgie, Stuttgart, Deutschland
| Published: | June 18, 2018 |
|---|
Outline
Text
Objective: Delayed cerebral ischemia (DCI) caused by cerebral vasospasm is a major cause for persistent neurological deficits or death following aneurysmal subarachnoid hemorrhage (aSAH). Angiographic, intra-arterial (i.a.) application of milrinone, a phosphodiesterase inhibitor, is known for medical dilation of cerebral vessels in vasospastic conditions. We evaluated the effect of angiographic milrinone application in aSAH patients with cerebral vasospasm (CV) over 24 hours.
Methods: From 2012 – 2017 57 patients (f:m 40:17) aged 52.54 (±10.04) years with a mean WFNS of 3.41 and Fisher Score of 3.28 received angiographic vessel reopening following aSAH for treatment of CV under ICU course. Eligibility criteria for i.a. milrinone infusion were the development of deterioration, a new focal neurological deficit and/or elevation above ≥ 120 cm/s in mean cerebral blood flow velocity (CBFV) in TCD of middle cerebral arteries (MCA). Studied patients were treated with slow i.a. milrinone infusion (8 mg over 30 min) into the internal carotid artery (ICA). To evaluate long-term effect of milrinone, repeated TCD of MCA was performed during the following 24 hours by an experienced neurosurgeon. Inclusion criteria were consistently documented data and no further invasive CV treatment besides oral or intra-venous nimodipine plus blood pressure management.
Results: 14 of 57 patients met our inclusion criteria and received 16 milrinone applications (f:m 10:4, mean age 52.16 (± 9.63)), WFNS score was 4.43 and Fisher score 3.07. Aneurysms were treated with coiling in 10 patients, 4 patients received clipping. 13 milrinone infusions were placed in both ICA while three were single side ICA infusions, milrinone infusion was performed after 8.75 (± 2.74) days post aSAH.
Baseline MCA mean blood flow velocity (BFV) was 159.13 (± 30.84) cm/s. In the following 24 h after milrinone application a decrease in MCA BFV to 129.54 (± 50.49) cm/s was seen. A reduction of 29.58 cm/s (p = 0.0245) in the following 24 h after i.a. milrinone application suggests a persistent effect. Mean Glasgow Outcome Score at discharge was 2.71, two patients died in the ICU.
Conclusion: Our data suggest that aSAH patients with severe CV could potentially benefit from a significant decrease in MCA mean CBFV following at 24 h after i.a. milrinone infusion. The effect should be verified in a larger patient cohort.
