J Korean Neurosurg Soc.  2012 Sep;52(3):172-178.

Angiographic Features and Clinical Outcomes of Intra-Arterial Nimodipine Injection in Patients with Subarachnoid Hemorrhage-Induced Vasospasm

• Kim SS
• Park DH
• Lim DJ
• Kang SH
• Cho TH
• Chung YG

Abstract

OBJECTIVE
The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes.
METHODS
We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms.
RESULTS
For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022).
CONCLUSION
IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

Keyword

Cerebral angiograms; Intra-arterial injection; Nimodipine; Ruptured aneurysm; Subarachnoid hemorrhage; Vasospasm

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Angiography
Blood Vessels
Glasgow Coma Scale
Glycosaminoglycans
Humans
Injections, Intra-Arterial
Intracranial Aneurysm
Nimodipine
Subarachnoid Hemorrhage
Vasodilation
Vasospasm, Intracranial
Glycosaminoglycans
Nimodipine

Figure

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  Fig. 1 The picture archiving and communication system has a magnifier, which is used to measure the blood vessel diameter before and after nimodipine injection. Vasodilation occurred from a diameter of 0.76 mm (A) to 1.10 mm (B).

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  Fig. 2 A : In this patient (patient No. 2), vasodilation occurred from a diameter of 0.9 mm (A) to 1.4 mm (B) in the A1 vessel. The degree of diameter increase appears to be 55%. The Glasgow Coma Scale (GCS) score increased from 13 to 14. B : In this patient (patient No. 4), vasodilation occurred from a diameter of 1.07 mm (A) to 1.4 mm (B) in the M2 vessel. The degree of diameter increase appeared to be 30%. The GCS score increased from 13 to 14.

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  Fig. 3 The change in the Glasgow Coma Scale score after intra-arterial (IA) nimodipine injection is significantly positively correlated with the change in blood vessel diameter after IA nimodipine injection (p=0.025). The power of the regression equation is 17.2%, and the t value is 2.370.

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  Fig. 4 The average time from subarachnoid hemorrhage (SAH) to the occurrence of cerebral vasospasm was 8.75 days, and the time interval from SAH to cerebral vasospasm was significantly positively correlated with the change in blood vessel diameter after intra-arterial nimodipine injection (p=0.040). The power of the regression equation is 14.8%, and the t value is 2.163.

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  Fig. 5 The average time from cerebral aneurysm clipping to cerebral vasospasm was 6.87 days. The time interval between clipping and vasospasm is significantly positively correlated with the change in blood vessel diameter after intra-arterial nimodipine injection (p=0.022). The power of the regression equation is 17.8%, and the t value is 0.2422.

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