Department of Neuroradiology, Aachen University Hospital, Aachen, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Clin Neuroradiol. 2024 Dec;34(4):809-815. doi: 10.1007/s00062-024-01424-0. Epub 2024 May 31.
The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate the effect of adding nimodipine to the guiding catheter flush (GCF) to prevent vasospasm during EVT.
This is a single-center retrospective analysis including patients with EVT (stent-retriever and/or distal aspiration) treated for anterior or posterior circulation intracranial vessel occlusion from January 2018 to June 2023. Exclusion criteria were intracranial or extracranial stenosis, intra-arterial alteplase, patient age over 80 years. Study groups were patients with (nimo+) and without (nimo-) nimodipine in the GCF. They were compared for occurrence of vasospasm as primary endpoint and clinical outcome in univariate analysis.
477 patients were included in the analysis (nimo+ n = 94 vs. nimo- n = 383). Nimo+ patients experienced less vasospasm during EVT (e.g. vasospasm in target vessel n (%): nimo- = 113 (29.6) vs. nimo+ = 9 (9.6), p < 0.001; extracranial vasospasm, n (%): nimo- = 68 (17.8) vs. nimo+ = 7 (7.4), p = 0.017). Patients of the two study groups had a comparable clinical outcome (90 day mRS, median (IQR): 3 (1-6) for both groups, p = 0.896). In general, patients with anterior circulation target vessel occlusion (TVO) experienced more vasospasm (anterior circ. TVO 38.7% vs. posterior circ. 7.5%, p = 0.006).
Prophylactic adding of nimodipine reduces the risk of vasospasm during EVT without affecting the clinical outcome. Patients with anterior circulation TVO experienced more vasospasm compared to posterior circulation TVO.
血管痉挛作为血管内卒中治疗（EVT）的并发症的临床重要性和处理方法尚未得到充分研究。我们旨在研究在 EVT 期间通过在引导导管冲洗（GCF）中添加尼莫地平来预防血管痉挛的效果。
这是一项单中心回顾性分析，纳入了 2018 年 1 月至 2023 年 6 月期间因前循环或后循环颅内血管闭塞接受 EVT（支架取栓和/或远端抽吸）治疗的患者。排除标准为颅内或颅外狭窄、动脉内使用阿替普酶、患者年龄超过 80 岁。研究组为 GCF 中添加（nimo+）和未添加（nimo-）尼莫地平的患者。对两组患者作为主要终点的血管痉挛发生率和单变量分析中的临床结果进行比较。
共纳入 477 例患者进行分析（nimo+组 n=94 例，nimo-组 n=383 例）。nimo+患者在 EVT 期间发生血管痉挛的比例较低（例如目标血管的血管痉挛 n（%）：nimo-组=113（29.6）比 nimo+组=9（9.6），p<0.001；颅外血管痉挛 n（%）：nimo-组=68（17.8）比 nimo+组=7（7.4），p=0.017）。两组患者的临床结局相似（90 天 mRS，中位数（IQR）：两组均为 3（1-6），p=0.896）。一般来说，前循环目标血管闭塞（TVO）的患者发生血管痉挛的比例更高（前循环 TVO 38.7%比后循环 TVO 7.5%，p=0.006）。
预防性添加尼莫地平可降低 EVT 期间发生血管痉挛的风险，而不影响临床结局。与后循环 TVO 相比，前循环 TVO 的患者发生血管痉挛的比例更高。
