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Hemorrhagic stroke
Original research
Intra-arterial nimodipine for the treatment of refractory delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage
  1. Laura Victoria Vossen1,
  2. Miriam Weiss1,2,
  3. Walid Albanna1,
  4. Catharina Conzen-Dilger1,
  5. Henna Schulze-Steinen3,
  6. Tobias Rossmann4,
  7. Tobias Phillip Schmidt1,
  8. Anke Höllig1,
  9. Martin Wiesmann5,
  10. Hans Clusmann1,
  11. Gerrit Alexander Schubert1,2,
  12. Michael Veldeman1
  1. 1Department of Neurosurgery, RWTH Aachen University Hospital Aachen, Aachen, Germany
  2. 2Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  3. 3Department of Intensive Care Medicine, RWTH Aachen University, Aachen, Germany
  4. 4Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
  5. 5Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany
  1. Correspondence to Dr Michael Veldeman, Neurosurgery, Universitätsklinikum Aachen, Aachen, Germany; mveldeman{at}ukaachen.de

Abstract

Background Delayed cerebral ischemia (DCI) is one of the main contributors to poor clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). Endovascular spasmolysis with intra-arterial nimodipine (IAN) may resolve angiographic vasospasm, but its effect on infarct prevention and clinical outcome is still unclear. We report the effect of IAN on infarction rates and functional outcome in a consecutive series of SAH patients.

Methods To assess the effectiveness of IAN, we collected functional outcome data of all SAH patients referred to a single tertiary center since its availability (2011–2020). IAN was primarily reserved as a last tier option for DCI refractory to induced hypertension (iHTN). Functional outcome was assessed after 12 months according to the Glasgow Outcome Scale (GOS, favorable outcome = GOS4-5).

Results Out of 376 consecutive SAH patients, 186 (49.5%) developed DCI. Thereof, a total of 96 (25.5%) patients remained unresponsive to iHTN and received IAN. DCI-related infarction was observed in 44 (45.8%) of IAN-treated patients with a median infarct volume of 111.6 mL (Q1: 51.6 to Q3: 245.7). Clinical outcome was available for 84 IAN-treated patients. Of those, a total of 40 (47.6%) patients reached a favorable outcome after 1 year. Interventional complications were observed in 9 (9.4%) of the IAN-treated patients.

Conclusion Intra-arterial spasmolysis using nimodipine infusion was associated with low treatment specific complications. Despite presenting a subgroup of severely affected SAH patients, almost half of IAN-treated patients were able to lead an independent life after 1 year of follow-up.

Trial registration number German Clinical Trial Register DRKS00030505.

  • subarachnoid
  • hemorrhage
  • stroke

Data availability statement

Data are available upon reasonable request. The raw data of this analysis can be made available by the authors to any qualified researcher upon reasonable request.

https://doi.org/10.1136/jnis-2023-021151

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    Data availability statement

    Data are available upon reasonable request. The raw data of this analysis can be made available by the authors to any qualified researcher upon reasonable request.

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    Footnotes

    • Contributors The design and conception of this trial was developed by MV and GAS. LVV, MiW, WA, CC-D, TR, were involved in data acquisition. All authors were involved in the interpretation of data. The manuscript was drafted by LV and MV. Illustrations were created by MV. The final manuscript was critically revised and approved by all authors. MV acts as guarantor for this publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.