Introduction During endovascular treatment of acute ischemic stroke (AIS), vasospasm can occur when materials used for mechanical thrombectomy come into contact with cerebral arteries. Nimodipine is commonly administered intra-arterially, but lowering blood pressure in AIS patients can increase neural loss affecting the patient‘s clinical outcome.

Aim of Study This study assessed whether continuous infusion of vasoactive amines counteracted the hypotensive effect of intra-arterial nimodipine in treating vasospasm during mechanical thrombectomy.

Methods Clinical and radiological records of AIS patients who underwent mechanical thrombectomy together with intra-arterial nimodipine were retrospectively analyzed. Mean arterial blood pressure (MABP) data were collected before, immediately after, and 10 minutes after nimodipine administration.

Results 75 patients receiving intra-arterial nimodipine for vasospasm during mechanical thrombectomy were included. Mean MABP after nimodipine injection was 81.79 ± 0.49 mmHg. Nimodipine effectively resolved arterial vasospasm in 76.3% of cases, aiding diagnosis of iatrogenic dissection or residual clot in other cases. TICI score ≥ 2b was achieved in 94.7% of cases, and 39 out of 72 patients (54%) had mRS ≤2. Comparing the ASPECT scores of the admission with that at 24 hours no shift was found in 77.9% of cases, shift of 1 point in 16.2% of cases and shift > 1 point in 5.9% of cases.

Conclusion Preventive administration of vasoactive amines and careful monitoring of MABP maintain recommended blood pressure during nimodipine administration in endovascular treatment for AIS. Nimodipine is useful in distinguishing vasospasm from iatrogenic dissection or residual clot.

Disclosure of Interest Paolo Machi is consultant for Striker and Medtronic.