Effect of Intra-arterial Nimodipine on Cerebral Oxygen Saturation and Cardiac Indices in Patients with Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Keywords

aneurysmal subarachnoid hemorrhage - IaN - SVRI

Introduction: Delayed cerebral ischemia from vasospasm results in morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH).[ ¹ ] Intraarterial nimodipine (IaN) relieves symptomatic vasospasm after aSAH with both angiographic and neurological improvement.[ ² ] However, hypotension is common during IaN treatment and can result in cerebral hypoperfusion thus negating the net benefit. This study aimed to assess the effect of IaN on cerebral oxygen saturation (cSO₂) and cardiac indices during IaN therapy for cerebral vasospasm.

Methodology/Description: The ISNACC-funded prospective cohort study was conducted in 17 patients over 16 months after ethics committee approval and informed consent. Patients with neurological/angiographic evidence of vasospasm received IaN (3 mg over 20 minutes) in the spastic vessel. The cSO₂, heart rate, mean blood pressure (MBP), and cardiac indices (cardiac index [CI], stroke volume index, stroke volume variation, and systemic vascular resistance index [SVRI]) were recorded from baseline until completion of IaN treatment.

Results: The mean age and BMI was 52.7 (10.8) years, 24.2 (3.6) kg/m², respectively. On paired t-test analysis, mean change in ipsilateral and contralateral cSO2 (%) after IaN was not significant (0.13 ± 3.7 [p = 0.89] and 1.3 ± 5.4 [p = 0.37], respectively). After IaN, mean change in diameter (mm) of spastic vessel was significant (0.48 ± 0.47; p = 0.007), but not in contrast transit time (sec; 1.3 ± 2.2; p = 0.08). Significant decrease in MBP (mm Hg) and SVRI (dyne*sec/cm^-5/m²) and increase in CI (L/min/m²) were noted after IaN (mean change 13.8 ± 11.8 (p < 0.001), 685 ± 644 (p = 0.001), and 0.62 ± 0.56 (p = 0.002), respectively.

Conclusion: IaN resulted in dilation of spastic vessel without change in cSO₂. Cardiac indices changed significantly with IaN.

• References

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