Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
World Neurosurg. 2022 Oct;166:e285-e293. doi: 10.1016/j.wneu.2022.06.150. Epub 2022 Jul 16.
The role of nimodipine and milrinone in the management of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) was studied using clinical and TCD (transcranial Doppler) parameters.
In this prospective observational study, patients with DCI after aneurysmal SAH presenting between November 2020 and June 2021 who were treated by either intra-arterial nimodipine (IAN) or intravenous milrinone (IVM) were included after excluding patients in whom both IAN and IVM had been given or mechanical angioplasty was performed. Twelve-hourly TCD was performed during the course of the therapy. Clinical improvement and the development of new brain infarcts were also assessed. A P value <0.05 was considered statistically significant.
Thirty-four patients fulfilled the inclusion criteria (IVM, 13/34 [38%]; IAN, 21/34 [62%]); patients in the IVM group (vs. IAN group) had poorer median Glasgow Coma Scale score (12 vs. 13), poorer motor response (<M6 response, 5/13 [38%] vs. 5/21 [24%]; P = 0.36) and higher grades (modified Fisher grade ≥3) of SAH (12/13 [92%] vs. 8/21 [86%]; P = 0.56). More patients in the IAN group (vs. IVM group) showed clinical improvement (17/21 [81%] vs. 10/13 [77%]; P = 0.77), development of new infarcts (15/21 [71%] vs. 7/13 [54%]; P = 0.29] and discharged to home (13/21 [62%] vs. 6/13 [46%]; P = 0.36) with less mortality (1/21 [9%] vs. 4/13 [23%]; P = 0.037). On TCD analysis, both IAN and IVM protocols showed similar effects in middle cerebral artery vasospasm; however, IAN proved better over time. In group-effect analysis, the IAN protocol was significantly better in anterior cerebral artery and posterior cerebral artery vasospasm compared with IVM protocol.
In this single-center small study, patients in the IAN group had significantly less mortality compared with the IVM group in the management of DCI after aneurysmal SAH.
通过临床和 TCD（经颅多普勒）参数研究尼莫地平与米力农在治疗动脉瘤性蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）中的作用。
在这项前瞻性观察性研究中，排除了接受动脉内尼莫地平（IAN）和静脉内米力农（IVM）治疗或接受机械血管成形术的患者后，纳入了 2020 年 11 月至 2021 年 6 月期间因 DCI 而出现的动脉瘤性 SAH 患者。在治疗过程中每 12 小时进行一次 TCD。还评估了临床改善和新脑梗死的发生情况。P 值<0.05 被认为具有统计学意义。
34 名患者符合纳入标准（IVM 组 13/34 [38%]；IAN 组 21/34 [62%]）；IVM 组（与 IAN 组相比）患者的中位格拉斯哥昏迷量表评分（GCS）较差（12 分比 13 分），运动反应较差（<M6 反应，5/13 [38%]比 5/21 [24%]；P=0.36），SAH 分级较高（改良 Fisher 分级≥3 级）（12/13 [92%]比 8/21 [86%]；P=0.56）。IAN 组（与 IVM 组相比）更多患者显示临床改善（17/21 [81%]比 10/13 [77%]；P=0.77）、发生新梗死（15/21 [71%]比 7/13 [54%]；P=0.29）和出院回家（13/21 [62%]比 6/13 [46%]；P=0.36），死亡率较低（1/21 [9%]比 4/13 [23%]；P=0.037）。TCD 分析显示，IAN 和 IVM 方案在大脑中动脉血管痉挛中均有相似的效果；然而，IAN 随时间推移效果更好。在组间效应分析中，IAN 方案在前循环和后循环血管痉挛方面明显优于 IVM 方案。
在这项单中心小研究中，IAN 组患者在治疗动脉瘤性 SAH 后 DCI 方面的死亡率明显低于 IVM 组。
