Vossen Laura Victoria, Weiss Miriam, Albanna Walid, Conzen-Dilger Catharina, Schulze-Steinen Henna, Rossmann Tobias, Schmidt Tobias Phillip, Höllig Anke, Wiesmann Martin, Clusmann Hans, Schubert Gerrit Alexander, Veldeman Michael
Department of Neurosurgery, RWTH Aachen University Hospital Aachen, Aachen, Germany.
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
J Neurointerv Surg. 2024 Dec 26;17(e1):e31-e40. doi: 10.1136/jnis-2023-021151.
Delayed cerebral ischemia (DCI) is one of the main contributors to poor clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). Endovascular spasmolysis with intra-arterial nimodipine (IAN) may resolve angiographic vasospasm, but its effect on infarct prevention and clinical outcome is still unclear. We report the effect of IAN on infarction rates and functional outcome in a consecutive series of SAH patients.
To assess the effectiveness of IAN, we collected functional outcome data of all SAH patients referred to a single tertiary center since its availability (2011-2020). IAN was primarily reserved as a last tier option for DCI refractory to induced hypertension (iHTN). Functional outcome was assessed after 12 months according to the Glasgow Outcome Scale (GOS, favorable outcome = GOS4-5).
Out of 376 consecutive SAH patients, 186 (49.5%) developed DCI. Thereof, a total of 96 (25.5%) patients remained unresponsive to iHTN and received IAN. DCI-related infarction was observed in 44 (45.8%) of IAN-treated patients with a median infarct volume of 111.6 mL (Q: 51.6 to Q: 245.7). Clinical outcome was available for 84 IAN-treated patients. Of those, a total of 40 (47.6%) patients reached a favorable outcome after 1 year. Interventional complications were observed in 9 (9.4%) of the IAN-treated patients.
Intra-arterial spasmolysis using nimodipine infusion was associated with low treatment specific complications. Despite presenting a subgroup of severely affected SAH patients, almost half of IAN-treated patients were able to lead an independent life after 1 year of follow-up.
German Clinical Trial Register DRKS00030505.
迟发性脑缺血（DCI）是动脉瘤性蛛网膜下腔出血（SAH）后临床预后不良的主要原因之一。动脉内注射尼莫地平（IAN）进行血管内解痉可能会缓解血管造影显示的血管痉挛，但其对预防梗死和临床预后的影响仍不明确。我们报告了IAN对一系列连续性SAH患者梗死率和功能预后的影响。
为评估IAN的有效性，我们收集了自其可用（2011 - 2020年）以来转诊至单一三级中心的所有SAH患者的功能预后数据。IAN主要留作诱导高血压（iHTN）难治性DCI的最后一线选择。12个月后根据格拉斯哥预后量表（GOS，良好预后 = GOS4 - 5）评估功能预后。
在376例连续性SAH患者中，186例（49.5%）发生了DCI。其中，共有96例（25.5%）患者对iHTN无反应并接受了IAN治疗。在接受IAN治疗的患者中，44例（45.8%）观察到与DCI相关的梗死，梗死体积中位数为111.6 mL（四分位数间距：51.6至245.7）。84例接受IAN治疗的患者有临床预后数据。其中，共有40例（47.6%）患者在1年后达到良好预后。9例（9.4%）接受IAN治疗的患者观察到介入并发症。
使用尼莫地平输注进行动脉内解痉治疗的并发症发生率较低。尽管是一组严重受影响的SAH患者，但几乎一半接受IAN治疗的患者在随访1年后能够独立生活。
德国临床试验注册DRKS00030505
