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Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: Influence on clinical course and predictors of clinical outcome

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@article{3bda68bf84564367838c435003d0d120,
title = "Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: Influence on clinical course and predictors of clinical outcome",
abstract = "Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course.",
keywords = "Female, Humans, Injections, Intra-Arterial, Male, Middle Aged, Nimodipine, Prognosis, Radiography, Retrospective Studies, Subarachnoid Hemorrhage, Treatment Outcome, Vasodilator Agents, Vasospasm, Intracranial, Journal Article",
author = "Asma Bashir and Morten Andresen and Jiri Bartek and Marie Cortsen and Vagn Eskesen and Aase Wagner",
note = "{\textcopyright} The Author(s) 2016.",
year = "2016",
month = feb,
doi = "10.1177/1971400915626429",
language = "English",
volume = "29",
pages = "72--81",
journal = "Rivista di Neuroradiologia",
issn = "0028-3940",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage

T2 - Influence on clinical course and predictors of clinical outcome

AU - Bashir, Asma

AU - Andresen, Morten

AU - Bartek, Jiri

AU - Cortsen, Marie

AU - Eskesen, Vagn

AU - Wagner, Aase

N1 - © The Author(s) 2016.

PY - 2016/2

Y1 - 2016/2

N2 - Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course.

AB - Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course.

KW - Female

KW - Humans

KW - Injections, Intra-Arterial

KW - Male

KW - Middle Aged

KW - Nimodipine

KW - Prognosis

KW - Radiography

KW - Retrospective Studies

KW - Subarachnoid Hemorrhage

KW - Treatment Outcome

KW - Vasodilator Agents

KW - Vasospasm, Intracranial

KW - Journal Article

U2 - 10.1177/1971400915626429

DO - 10.1177/1971400915626429

M3 - Journal article

C2 - 26825134

VL - 29

SP - 72

EP - 81

JO - Rivista di Neuroradiologia

JF - Rivista di Neuroradiologia

SN - 0028-3940

IS - 1

ER -

ID: 49631430