Clinical Course and Monitoring Parameters After Continuous Interventional Intra-Arterial Treatment in Patients with Refractory Cerebral Vasospasm.

BACKGROUND: In aneurysmal subarachnoid haemorrhage cerebral vasospasm leads to clinical worsening and poor outcome. Interventional treatment with nimodipine might be a therapeutic option.

OBJECTIVE: To evaluate the clinical course of patients with different interventional treatment types.

METHODS: A retrospective, observational analysis was performed. Inclusion criteria were aneurysmal subarachnoid haemorrhage, clinical and/or radiologic evidence of vasospasm and interventional intra-arterial treatment. Patients were divided into 3 groups: continuous nimodipine infusion, repetitive nimodipine infusions, and singular nimodipine infusion. Pre- and postinterventional parameters were analyzed to evaluate the efficacy of the procedure in terms of responder status. Outcome was determined using the modified Rankin scale.

RESULTS: A total of 163 interventions (97 patients) were examined. Patients with continuous treatment showed a greater World Federation of Neurological Surgeons grade. Response to intra-arterial nimodipine in the continuous group was comparatively worse. Transcranial Doppler monitoring as well as brain tissue oxygenation measuring showed good correlation with imaging results. The rate of intraprocedural complications in the continuous treatment group was significantly greater. We observed a worse clinical outcome in the patients who underwent continuous treatment. None of the patients in the continuous group achieved favorable outcome after 3 months.

CONCLUSIONS: Facing the poor clinical outcome and the greater complication rate, continuous intra-arterial infusion of nimodipine in patients with angiographically refractory cerebral vasospasm has to be indicated strictly. Transcranial Doppler and brain tissue oxygenation monitoring seem to be reliable tools for evaluation of the clinical postinterventional course.