caa a22 4500 606214666 CHVBK 20210128101054.0 cr unu---uuuuu 210128e20151201xx s 000 0 eng 10.1007/s00701-015-2597-z doi (NATIONALLICENCE)springer-10.1007/s00701-015-2597-z Continuous intra-arterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a feasibility study and outcome results [Elektronische Daten] [Sylvia Bele, Martin Proescholdt, Andreas Hochreiter, Gerhard Schuierer, Judith Scheitzach, Christina Wendl, Martin Kieninger, Andre Schneiker, Elisabeth Bründl, Petra Schödel, Karl-Michael Schebesch, Alexander Brawanski] Background: Severe cerebral vasospasm is a major cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. No causative treatment is yet available and hypertensive hypervolemic therapy (HHT) is often insufficient to avoid delayed cerebral ischemia and neurological deficits. We compared patients receiving continuous intra-arterial infusion of the calcium-antagonist nimodipine with a historical group treated with HHT and oral nimodipine alone. Methods: Between 0.5 and 1.2mg/h of nimodipine were continuously administered by intra-arterial infusion via microcatheters either into the internal carotid or vertebral artery or both, depending on the areas of vasospasm. The effect was controlled via multimodal neuromonitoring and transcranial Doppler sonography. Outcome was determined by means of the Glasgow Outcome Scale at discharge and 6months after the hemorrhage and compared to a historical control group. Results: Twenty-one patients received 28 intra-arterial nimodipine infusions. Six months after discharge, the occurrence of cerebral infarctions was significantly lower (42.6%) in the nimodipine group than in the control group (75.0%). This result was reflected by a significantly higher proportion (76.0%) of patients with good outcome in the nimodipine-treated group, when compared to 10.0% good outcome in the control group. Median GOS was 4 in the nimodipine group and 2 in the control group (p = 0.001). Conclusions: Continuous intra-arterial nimodipine infusion is an effective treatment for patients with severe cerebral vasospasm who fail to respond to HHT and oral nimodipine alone. Key to the effective administration of continuous intra-arterial nimodipine is multimodal neuromonitoring and the individual adaptation of dosage and time of infusion for each patient. Springer-Verlag Wien, 2015 Continuous intra-arterial nimodipine infusion (CIAN) nationallicence Cerebral vasospasm (CV) nationallicence Subarachnoid hemorrhage nationallicence Improved outcome nationallicence Bele Sylvia Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Proescholdt Martin Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Hochreiter Andreas Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Schuierer Gerhard Department of Neuroradiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Scheitzach Judith Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Wendl Christina Department of Neuroradiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Kieninger Martin Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Schneiker Andre Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Bründl Elisabeth Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Schödel Petra Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Schebesch Karl-Michael Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Brawanski Alexander Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut Acta Neurochirurgica Springer Vienna 157/12(2015-12-01), 2041-2050 0001-6268 157:12<2041 2015 157 701 https://doi.org/10.1007/s00701-015-2597-z text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2597-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bele Sylvia Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Proescholdt Martin Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Hochreiter Andreas Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Schuierer Gerhard Department of Neuroradiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Scheitzach Judith Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Wendl Christina Department of Neuroradiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Kieninger Martin Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Schneiker Andre Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Bründl Elisabeth Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Schödel Petra Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Schebesch Karl-Michael Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 700 1- Brawanski Alexander Department of Neurosurgery, University Medical Center Regensburg, Franz Josef Strauß Allee 11, 93053, Regensburg, Germany aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/12(2015-12-01), 2041-2050 0001-6268 157:12<2041 2015 157 701