Behandlung von cerebralen Vasospasmen nach einer aneurysmatischen Subarachnoidalblutung mit intraarterieller Gabe von Nimodipin

Cerebral vasospasm is a significant complication following aneurysmal subarachnoid hemorrhage contributing to an unfavorable neurological outcome. Intraarterial Nimodipine is used to treat cerebral vasospasm after subarachnoid hemorrhage. However, there are insufficient data on the efficacy and outcomes of intraarterial spasmolysis. The aim of this study was to collect demographic data and assess the outcome.

A database with patients who underwent intraarterial vasospasmolysis with Nimodipine at our institute between 2011-2021 was analysed. We identified 229 eligible patients. The modified Rankin Scale (mRS) was used to assess clinical outcome (favorable outcome <2; unfavorable 3-5).

In this series, 176 of the total 229 patients were female (76.9%), while 53 patients were male (23.1%). The mean age was 56.4 years. The majority of patients were classified as grade 4 (56 patients, 24.5%) and grade 5 (62 patients, 27.0%) according to the Hunt and Hess classification. In 167 patients (73.0%), the ruptured aneurysm was treated by clipping, while in 56 patients (24.5%), the aneurysm was coiled. A total of 129 patients (56.3%) underwent a single intraarterial vasospasmolysis, in 44 patients (19.2%), vasospasmolysis was performed twice, and the remainder (24.5%) underwent vasospasmolysis more than two times. The median follow-up time for 168 patients was 4 months (range: 3-12 months). 26.6% of patients were lost to follow-up. A favorable outcome was achieved in 47% of patients, while 26.2% had an unfavorable outcome. The remainder (26.8%) died. No significant difference was found between the group of patients with single vasospasmolysis and the group with multiple vasospasmolysis (P > 0.05). A non-significant small positive correlation was found between the number of repeated vasospasmolysis and the mRS (Spearman´s r=0,112. P > 0.05).

Intraarterial Nimodipine is safe and a likely effective method for the treatment of severe cerebral vasospasm. Further research is needed to understand the long-term benefits of intraarterial Nimodipine treatment.