| Effectiveness of Continuous Intra-Arterial Nimodipine Infusion for the Treatment of Refractory Vasospasm after Aneurysmal Subarachnoid Hemorrhage |
Hyunbong Lee1
, Jongjoo Lee1
, Myung Sub Kim2
, Jiwook Ryu3
, Youngbo Shim4
, Yeongu Chung1
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1Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
3Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
4Department of Critical Care Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea |
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Received: December 31, 2024; Revised: April 3, 2025 Accepted: April 14, 2025. Published online: April 16, 2025. |
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| ABSTRACT |
Objective
: Delayed cerebral ischemia (DCI) is a severe complication following aneurysmal subarachnoid hemorrhage (aSAH), potentially leading to functional impairments. Cerebral vasospasm (CVS) is one of the primary mechanisms of DCI. In cases of medically refractory CVS, intra-arterial (IA) nimodipine is a rescue treatment, but its effectiveness can be insufficient. We hypothesized that continuous IA nimodipine infusion (CIAN) could serve as a salvage treatment, and we evaluated its effectiveness and safety.
Methods
: We evaluated 274 patients with aSAH admitted between October 2017 and February 2024, identifying those who received IA nimodipine and those who also received CIAN. The modified Rankin Scale (mRS) score at discharge was assessed in the CIAN group, and patient and disease characteristics, length of stay, and discharge mRS scores were compared between the conventional IA nimodipine and the CIAN groups.
Results
: Of the 274 patients, 15 received IA nimodipine, and five of those underwent CIAN. More females were observed in the medically refractory CVS group compared with the non-refractory group (87% [13/15] vs. 66% [171/259]), but there was no sex difference between the CIAN and conventional IA nimodipine groups. CIAN was initiated at a mean of 9 days after the onset of aSAH and continued for 21–81 hours. Two complications were noted, including severe brain edema and suspected heparin-induced thrombocytopenia. However, radiological assessments showed no new lesions. The CIAN group exhibited a longer duration of abnormal findings on transcranial Doppler compared to the conventional IA group (16.0±10.1 vs. 9.4±7.9 days), as well as longer NCU (17.4±10.1 vs. 14.1±7.0 days) and hospital stays (46.6±28.7 vs. 29.5±14.1 days). Nonetheless, more achieved a favorable outcome (mRS≤2) in the CIAN group (80% [4/5] vs. 70% [7/10]).
Conclusion
: CIAN is a viable salvage treatment for refractory CVS, providing a prolonged vasodilatory effect compared to conventional IA nimodipine, with favorable outcomes. |
| Key Words:
Aneurysmal subarachnoid hemorrhage · Cerebral vasospasm · Continuous intra-arterial nimodipine · Delayed cerebral ischemia · Endovascular treatment |
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