Chemical angioplasty with spasmolytics for vasospasm after subarachnoid hemorrhage
Jazyk angličtina Země Rakousko Médium print-electronic
Typ dokumentu časopisecké články
PubMed
28224318
DOI
10.1007/s00701-017-3104-5
PII: 10.1007/s00701-017-3104-5
Knihovny.cz E-zdroje
- Klíčová slova
- Angiography, Cerebral vasospasm, Microdialysis, Milrinone, Nimodipine, Outcome, Spasmolytics, Transcranial dopplerometry,
- MeSH
- angioplastika škodlivé účinky metody MeSH
- dospělí MeSH
- intraarteriální infuze škodlivé účinky MeSH
- intrakraniální vazospazmus farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nimodipin aplikace a dávkování terapeutické užití MeSH
- subarachnoidální krvácení farmakoterapie MeSH
- vazodilatancia aplikace a dávkování terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- nimodipin MeSH
- vazodilatancia MeSH
BACKGROUND: Clinically symptomatic vasospasm leading to delayed ischemic neurological deficits occurs in up to 30% of patients with subarachnoid hemorrhage (SAH). Vasospasm can result in a serious decline in clinical conditions of patients with SAH, yet the algorithm for vasospasm treatment and prevention remains unclear. Intra-arterial administration of vasodilators is one of the modalities used for vasospasm therapy. METHODS: Over the last 7 years, we have treated 27 female and 7 male patients with vasospasm using intra-arterial administration of either nimodipine or milrinone; all had suffered aneurysm rupture. Of these patients, 28 were treated surgically (clip), and 6 patients had their aneurysm coiled. Spasmolytics were applied from day 2 to day 18 after rupture. RESULTS: Of the 53 procedures, angiographic improvement was documented in 92% of cases with a mean flow velocity decrease of 65 cm/s. Brain metabolism changes were monitored after the procedure. The highest level of immediate clinical improvement was observed in conscious patients with a focal neurological deficit (aphasia, hemiparesis). Overall clinical outcomes (Glasgow outcome scale, GOS) were as follows: GOS 5 (12 patients), GOS 4 (5 patients), GOS 3 (5 patients), GOS 2 (6 patients), and GOS 1 (6 patients). CONCLUSIONS: Intra-arterial administration of spasmolytics is a safe and potent method of vasospasm treatment. It is most effective when applied to conscious patients with a focal deficit. For unconscious patients, its therapeutic benefits are inconclusive. Patients in severe clinical states would further require use of other diagnostic tools such as multimodal brain monitoring to complement vasospasm therapy.
Department of Mathematics Faculty of Science J E Purkinje University Ústí nad Labem Czech Republic
Department of Radiology Masaryk Hospital Ústí nad Labem Czech Republic
International Clinical Research Center St Anne's University Hospital Brno Czech Republic
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