Adverse Events and Complications in Continuous Intra-arterial Nimodipine Infusion Therapy After Aneurysmal Subarachnoid Hemorrhage

Abstract

ObjectiveTo determine the frequency and severity of complications associated with the continuous intra-arterial infusion of nimodipine (CIANI) as a new treatment of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH).MethodsPatients from two centers (n = 718) treated for SAH between 2008 and 2016 were included. Demographic and SAH-related parameters were evaluated, and also the frequency of adverse events (AEs) and complications including their severity (mild, moderate, and severe). Clinical outcome was analyzed using Glasgow Outcome Scale (GOS). The unfavorable outcome was defined as GOS 1 to 3, and favorable outcome as GOS 4 to 5. The Short-Form 36 (SF-36) health-related quality-of-life (QoL) questionnaire served as a QoL measurement.ResultsOf 718 patients, 65 (9%) were treated by CIANI and had a higher clinical or imaging grade of bleeding severity. Clinical deterioration while on treatment happened more often in patients who were treated with CIANI than in others. In patients with CIANI, 67% had AEs and/or complications during the treatment. Nimodipine-associated hypotension was seen in 8% (mild). Catheter-associated thrombus occurred in 9% (moderate). New intracerebral hemorrhage was found in 14% (moderate). A total of 6% treated by CIANI died during the treatment period (severe). More than one-third (39%) of patients of CIANI reached at least moderate disability, and 23% showed good recovery. Patients who received CIANI showed reduced QoL, but differences in mental and general health, and also pain were minimal.ConclusionPatients who received CIANI had higher rates of AEs and complications. However, this does not exclude the possibility that the use of CIANI might be helpful in patients with severe and therapy-refractory CV and DCI. Controlled and randomized studies would be helpful to clarify this question but they are methodologically and ethically challenging.

Evaluation of DeGIR registry data on endovascular treatment of cerebral vasospasm in Germany 2018–2021: an overview of the current care situation

“…Long-term drug treatment with a microcatheter infusion was found in the cohort studied in 1132 (14.8 %) of all interventions. This procedure has already been described with a relatively high overall number of side effects and at least an increased rate of catheter-associated thromboembolism 13 . Even after our evaluation, the complication rate was 2.7 % higher than the total number of EVT (1.1 %).…”

“…Medikamentöse Dauerbehandlungen mit einer Mikrokatheter-Infusion wurden im untersuchten Kollektiv bei 1132 (14,8 %) aller Interventionen gefunden. Dieses Verfahren ist bereits mit einer insgesamt relativ hohen Nebenwirkungs- und zumindest auch erhöhten katheterassoziierten Thromboembolierate vorbeschrieben worden 13 . Auch nach unserer Auswertung war die Komplikationsrate mit 2,7 % höher als bei der Gesamtzahl der EST (1,1 %).…”

“…Die BA wird ganz überwiegend zusätzlich zur medikamentösen EST durchgeführt, mit sowohl Non-Compliant-als auch Compliant-Ballonkathetern [12]. Außerdem kommen lokale medikamentöse Dauertherapien unter Verwendung von Mikrokathetern sowie Gefäßdilatationen mit Stentretrievern oder anderen nicht okklusiven Stents zur Anwendung [13][14][15]. Ferner sind bei rekurrenten ZVS auch Fallserien zur dauerhaften Stentangioplastie zu finden [16].…”

Neuroradiological diagnosis and therapy of cerebral vasospasm after subarachnoid hemorrhage

“…In individual institutions continuous treatment involving the intraarterial administration of medication via microcatheters is used to treat vasospasms. This is recommended particularly in severe otherwise treatment-refractory cases even under consideration of potentially serious side effects like thromboembolic events [61][62][63]. Therefore, such continuous intraarterial treatments involving the application of vasodilators for several days are more effective than short infusions even though systematic examinations including the specific comparison of these two endovascular methods are still lacking.…”

Treating Delayed Cerebral Ischemia: Should We Focus on Blood Pressure or Vasodilatation?

“…The rate of complications will likely constrain widespread adoption in the absence of prospective studies. 19 Moreover, the specific use of intraarterial nimodipine cannot be adopted in the United States, since its intravenous formation is not approved by the Food and Drug Administration.…”