Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm

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Abstract

Objective: The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. Methods: We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. Results: For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vaso-spasm and the change in diameter (p=0.022). Conclusion: IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our fndings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

Original languageEnglish
Pages (from-to)172-178
Number of pages7
JournalJournal of Korean Neurosurgical Society
Volume52
Issue number3
DOIs
Publication statusPublished - 2012 Sep 1

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Intra-Arterial Injections
Nimodipine
Subarachnoid Hemorrhage
Intracranial Vasospasm
Vasodilation
Glasgow Coma Scale
Angiography
Doppler Ultrasonography
Ruptured Aneurysm
Spasm
Intracranial Aneurysm
Aneurysm
Blood Vessels
Regression Analysis

Keywords

  • Cerebral angiograms
  • Intra-arterial injection
  • Nimodipine
  • Ruptured aneurysm
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Surgery
  • Neuroscience(all)
  • Clinical Neurology

Cite this

@article{efcaf42bdafe47ffaa7665f12bc55407,
title = "Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm",
abstract = "Objective: The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. Methods: We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. Results: For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vaso-spasm and the change in diameter (p=0.022). Conclusion: IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our fndings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.",
keywords = "Cerebral angiograms, Intra-arterial injection, Nimodipine, Ruptured aneurysm, Subarachnoid hemorrhage, Vasospasm",
author = "Kim, {Sang Shin} and Dong-Hyuk Park and Lim, {Dong Jun} and Shin-Hyuk Kang and Cho, {Tai Hyoung} and Chung, {Yong Gu}",
year = "2012",
month = "9",
day = "1",
doi = "10.3340/jkns.2012.52.3.172",
language = "English",
volume = "52",
pages = "172--178",
journal = "Journal of Korean Neurosurgical Society",
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TY - JOUR

T1 - Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm

AU - Kim, Sang Shin

AU - Park, Dong-Hyuk

AU - Lim, Dong Jun

AU - Kang, Shin-Hyuk

AU - Cho, Tai Hyoung

AU - Chung, Yong Gu

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Objective: The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. Methods: We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. Results: For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vaso-spasm and the change in diameter (p=0.022). Conclusion: IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our fndings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

AB - Objective: The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. Methods: We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. Results: For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vaso-spasm and the change in diameter (p=0.022). Conclusion: IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our fndings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

KW - Cerebral angiograms

KW - Intra-arterial injection

KW - Nimodipine

KW - Ruptured aneurysm

KW - Subarachnoid hemorrhage

KW - Vasospasm

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U2 - 10.3340/jkns.2012.52.3.172

DO - 10.3340/jkns.2012.52.3.172

M3 - Article

VL - 52

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EP - 178

JO - Journal of Korean Neurosurgical Society

JF - Journal of Korean Neurosurgical Society

SN - 2005-3711

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