The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

Lannes, Marcelo; Zeiler, Frederick A.; Guichon, Céline; Teitelbaum, Jeanne

doi:10.1017/cjn.2016.316

Cited by 38 publications

(27 citation statements)

References 35 publications

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“…[7][8][9][10][11] However, the modality of delivery and dosing differ among centers. 12 Since 1998, our institution's protocol for the treatment of symptomatic cerebral vasospasm/DCI has been to administer an intravenous (IV) bolus followed by continuous IV perfusion of milrinone, with increases in dosage according to the patient's clinical response. The use of this protocol was associated with a lower incidence of both emergency angiograms and salvage angioplasty.…”

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Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia

Abulhasan

Jiménez

Teitelbaum

et al. 2021

Journal of Neurosurgery

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OBJECTIVEIntravenous (IV) milrinone is a promising option for the treatment of cerebral vasospasm with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, data remain limited on the efficacy of treating cases that are refractory to standard therapy with IV milrinone. The aim of this study was to determine predictors of refractory vasospasm/DCI despite treatment with IV milrinone, and to analyze the outcome of rescue therapy with intraarterial (IA) milrinone and/or mechanical angioplasty.METHODSThe authors conducted a retrospective cohort study of all patients with aSAH admitted between 2010 and 2016 to the Montreal Neurological Institute and Hospital. Patients were stratified into 3 groups: no DCI, standard therapy, and rescue therapy. The primary outcome was frequency of DCI-related cerebral infarction identified on neuroimaging before hospital discharge. Secondary outcomes included functional outcome reported as modified Rankin Scale (mRS) score, and segment reversal of refractory vasospasm.RESULTSThe cohort included 322 patients: 212 in the no DCI group, 89 in the standard therapy group, and 21 in the rescue therapy group. Approximately half (52%, 168/322) were admitted with poor-grade aSAH at treatment decision (World Federation of Neurosurgical Societies grade III–V). Among patients with DCI and imaging assessing severity of vasospasm, 62% (68/109) had moderate/severe radiological vasospasm on DCI presentation. Nineteen percent (21/110) of patients had refractory vasospasm/DCI and were treated with rescue therapy. Targeted rescue therapy with IA milrinone reversed 32% (29/91) of the refractory vasospastic vessels, and 76% (16/21) of those patients experienced significant improvement in their neurological status within 24 hours of initiating therapy. Moderate/severe radiological vasospasm independently predicted the need for rescue therapy (OR 27, 95% CI 8.01–112). Of patients with neuroimaging before discharge, 40% (112/277) had developed new cerebral infarcts, and only 21% (23/112) of these were vasospasm-related. Overall, 65% (204/314) of patients had a favorable functional outcome (mRS score 0–2) assessed at a median of 4 months (interquartile range 2–8 months) after aSAH, and there was no difference in functional outcome between the 3 groups (p = 0.512).CONCLUSIONSThe aggressive use of milrinone was safe and effective based on this retrospective study cohort and is a promising therapy for the treatment of vasospasm/DCI after aSAH.

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Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia

Abulhasan

Jiménez

Teitelbaum

et al. 2021

Journal of Neurosurgery

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“…Important to notice though, that in these studies, patients who did not recover from the coma status were excluded. Furthermore, evidence about treatment of DCI with milrinone and its use to improve outcomes in patients with SAH, come from studies regarded of very low quality …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, evidence about treatment of DCI with milrinone and its use to improve outcomes in patients with SAH, come from studies regarded of very low quality. 14 Milrinone is an inhibitor of phosphodiesterase III, with positive inotropic and vasodilatory effects. 1,2 Although intraarterial milrinone contributes to the reduction of VSP, this usually requires concomitant use of angiography.…”

Section: Discussionmentioning

confidence: 99%

Intravenous administration of Milrinone, as an alternative approach to treat vasospasm in subarachnoid hemorrhage: A case report of transcranial Doppler monitoring

Santos‐Teles

Passos

Panerai

et al. 2019

Clinical Case Reports

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“…Dentre os vasodilatadores intra-arteriais, a milrinona (inibidor da fosfodiesterase-3) mostra ser a melhor opção, por apresentar um melhor desfecho tardio e melhora do vasoespamo angiográfico. No entanto, ainda não existem Case Report ensaios clínicos randomizados para confirmar sua eficácia 2,5,7,9,20,25,26,33,37,40,45 . A milrinona, quando usada intratecal ainda tem demonstrado redução na taxa de isquemia cerebral tardia, porém os estudos possuem pontos relevantes a se considerar, como "n" pequeno e ausência de grupos controle 6,35 .…”

Section: Introdução Relato De Casounclassified

“…A milrinona, quando usada intratecal ainda tem demonstrado redução na taxa de isquemia cerebral tardia, porém os estudos possuem pontos relevantes a se considerar, como "n" pequeno e ausência de grupos controle 6,35 . Além das vias já citadas, a milrinona ainda pode ser utilizada endovenosa, com bomba de infusão 5,7,10,[23][24][25][26]45 . No caso descrito, foi utilizada a milrinona em duas vias, intra-arterial e endovenosa (EV).…”

Section: Introdução Relato De Casounclassified

Uso de Milrinona Endovenosa no Tratamento do Vasoespasmo Cerebral Pós-HSA Espontânea. Relato de Caso

Souza

Leal

Meneses

et al. 2020

jbnc

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Introdução: O vasoespasmo cerebral (VC) é a segunda maior causa de morbimortalidade em HSA aneurismática. Apesar da indicação do uso de nimodipino para sua prevenção ser bem estabelecida, ela não é totalmente eficaz. Logo, faz-se necessário o estudo de abordagens para o tratamento do VC. Nos últimos anos, a milrirona vem demonstrando eficácia para o tratamento do vasoespasmo seja em seu uso intra-arterial (IA) em dose única, em forma de bomba de infusão endovenosa ou intratecal por cateter lombar. Objetivo: Descrever um caso do uso da milrinona na abordagem terapêutica do VC. Métodos: Neste artigo relatamos um caso do uso combinado de milrinona IA (10 mL) e em bomba de infusão (0,375 mcg/kg/min) no tratamento do VC. Resultados: A paciente apresentou melhora clínica, e a angiografia por subtração digital mostrou melhora após dose IA e no controle após 4 dias de bomba de infusão. Conclusão: A associação de milrinona intra-arterial e endovenosa apresentou desfecho favorável clínico e radiológico.

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The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

Cited by 38 publications

References 35 publications

Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia

Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia

Intravenous administration of Milrinone, as an alternative approach to treat vasospasm in subarachnoid hemorrhage: A case report of transcranial Doppler monitoring

Uso de Milrinona Endovenosa no Tratamento do Vasoespasmo Cerebral Pós-HSA Espontânea. Relato de Caso

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