Department of Neurosurgery, Klinikum Stuttgart, Germany.
Neurosurgery. 2011 Jun;68(6):1541-7; discussion 1547. doi: 10.1227/NEU.0b013e31820edd46.
Cerebral vasospasm (CV) is a potentially disastrous consequence of subarachnoid hemorrhage despite medical treatment. Nimodipine is a potent drug for vessel relaxation, but side effects may preclude a sufficient dose.
To explore whether continuous local intra-arterial nimodipine administration (CLINA) can reverse vasospasm and prevent delayed ischemic neurological deficit.
Six consecutive subarachnoid hemorrhage patients (5 women; mean age, 47.2 years) with severe CV despite maximum medical therapy underwent CLINA within 2 hours after the onset of clinical symptoms. After anticoagulation, microcatheters were inserted distally in the concerning supra-aortic vessels. Glyceryl trinitrate injection (2 mg) was followed by CLINA (nimodipine 0.4 mg/h for 70-147 hours). Duration of CLINA was determined by neurological status, transcranial Doppler sonography, and partial tissue oxygen pressure values.
In all patients, neurological deficits improved or partial tissue oxygen pressure values returned to normal and transcranial Doppler sonography confirmed a reduced blood flow velocity within 12 hours. Magnetic resonance imaging showed no ischemic lesion caused by CV. Neurological outcome was good (modified Rankin Scale score, 0-2) in 3 patients, whereas 1 patient had a moderate clinical outcome (modified Rankin Scale score, 3-4) and 2 patients had a poor outcome (modified Rankin Scale score, 5) because of the SAH.
Preliminary data show that CLINA is a straightforward, effective, and safe option for patients with severe CV refractory to medical therapy. Dilation of spastic arteries starts within a few hours and is lasting. Indication for CLINA is peripheral and diffuse CV at any location.
尽管进行了医学治疗，脑血管痉挛（CV）仍是蛛网膜下腔出血的一种潜在灾难性后果。尼莫地平是一种有效的血管松弛药物，但副作用可能会排除足够的剂量。
探讨持续局部动脉内尼莫地平给药（CLINA）是否能逆转血管痉挛并预防迟发性缺血性神经功能缺损。
6 例连续的蛛网膜下腔出血患者（5 例女性；平均年龄 47.2 岁），尽管接受了最大的药物治疗，但仍出现严重的 CV，在出现临床症状后 2 小时内接受 CLINA。抗凝后，微导管远端插入相关的主动脉上血管。注射硝化甘油（2mg）后，给予 CLINA（尼莫地平 0.4mg/h，持续 70-147 小时）。CLINA 的持续时间由神经状态、经颅多普勒超声和部分组织氧分压值决定。
所有患者的神经功能缺损均改善或部分组织氧分压值恢复正常，经颅多普勒超声证实血流速度在 12 小时内降低。磁共振成像显示无 CV 引起的缺血性病变。3 例患者的神经功能预后良好（改良 Rankin 量表评分 0-2），1 例患者的临床预后中度（改良 Rankin 量表评分 3-4），2 例患者的预后不良（改良 Rankin 量表评分 5），因为有蛛网膜下腔出血。
初步数据表明，CLINA 是一种简单、有效、安全的治疗方法，适用于对药物治疗无效的严重 CV 患者。痉挛动脉的扩张在数小时内开始并持续。CLINA 的适应证是任何部位的外周性和弥漫性 CV。
