CONTINUOUS INTRAVENOUS NIMODIPINE APPLICATION FOR PREVENTION OF VASOSPASM BEFORE ENDOVASCULAR TREATMENT OF RUPTURED CEREBRAL ANEURISMS

  • Jasna M. Bushinoska Clinic for Anesthesiology, Reanimation and Intensive care, Clinical Center Mother Theresa, Skopje, North Macedonia
  • Aleksandar Chaparoski Clinic for Neurosurgery, Clinical Center Mother Theresa, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Menka Lazareska Radiology Institute, Clinical Center Mother Theresa, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Gabriela Bushinoska-Ivanova Clinic for Gynecology and Obstetrics, Clinical Center Mother Theresa, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Ljubomir Ognjenovic Clinic for Digestive Surgery, Clinical Center Mother Theresa, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Milenko Kostov Clinic for Neurosurgery, Clinical Center Mother Theresa, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Elmedina Asani Clinic for Neurosurgery, Clinical Center Mother Theresa, Skopje,
  • Dina Zafirova Clinic for Anesthesiology, Reanimation and Intensive care, Clinical Center Mother Theresa, Skopje
  • Marija Vesova Clinic for Neurosurgery, Clinical Center Mother Theresa, Skopje,

Abstract

Early recognition of vasospasm (VS) in patients with aneurismal subarachnoid hemorrhage (aSAH) is an imperative for timely treatment and prevention of delayed cerebral ischemia (DCI). VS, the pathologic response of the vascular damage in aSAH, is the main risk factor for irreversible brain damage. The first step in successful solving of aneurismal bleeding is prevention and treatment of VS. The aim of this study is to determine whether medical treatment with continuous infusion of intravenous Calcium blocker Nimodipine, without radiology verified VS will impact the degree of arterial vasoconstriction during the endovascular aneurismal treatment (EVT). A total of 20 patients with aSAH, confirmed by CT-angiography and hospitalized in UC for Neurosurgery were included in the study. In 10 patients, a continuous iv Nimodipine infusion was initiated on admission, the other half remained on their own antihypertensive therapy. If signs of VS or neurologic deterioration had developed, iv vasodilator therapy would have been initiated. Control angiography and immediate EVT were performed on the 4th day of admission at Radiology Institute. Using angiography, the vascular diameter was measured and compared with the same vessel diameter on CTA, to determine whether iv Nimodipine is effective in the pretreatment period. In 8 of 10 treated patients with iv Nimodipine, VS resolved in preEVT period. Among the patients from the non-treated group, 1 had developed DCI, 1 had no VS, 6 had persistent and in 2 patients VS resolved spontaneously. The conclusion is that continuous iv Nimodipine in preEVT period has vasodilatory potency on the vascular pool.


Key words: Aneurismal subarachnoid hemorrhage, vasospasm, intravenous Nimodipine, endovascular treatment

References

1. Castanares-Zapatero, D., Hantson, P. Pharmacological treatment of delayed cerebral ischemia and vasospasm in subarachnoid hemorrhage. Ann. Intensive Care 1, 12 (2011). https://doi.org/10.1186/2110-5820-1-12
2. M Das J, Zito PM. Nimodipine. [Updated 2021 Nov 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534870/
3. Azarov I, He X, Jeffers A, et al. Rate of nitric oxide scavenging by hemoglobin bound to haptoglobin. Nitric Oxide. 2008;18(4):296-302. doi:10.1016/j.niox.2008.02.006
4. Eisenhut M. Vasospasm in cerebral inflammation. Int J Inflam. 2014;2014:509707. doi:10.1155/2014/509707
5. Carr KR, Zuckerman SL, Mocco J. Inflammation, cerebral vasospasm, and evolving theories of delayed cerebral ischemia. Neurol Res Int. 2013;2013:506584. doi:10.1155/2013/506584
6. Chih-Lung Lin, Aaron S. Dumont, John H. Zhang, Mario Zuccarello, Carl Muroi, "Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Mechanism and Therapies", BioMed Research International, vol. 2014, Article ID 679014, 3 pages, 2014. https://doi.org/10.1155/2014/679014
7. Budohoski KP, Guilfoyle M, Helmy A, et alThe pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhageJournal of Neurology, Neurosurgery & Psychiatry 2014;85:1343-1353.
8. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G; European Stroke Organization. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93-112. doi: 10.1159/000346087. Epub 2013 Feb 7. PMID: 23406828.
9. Li Y, Fang W, Tao L, Li M, Yang Y, Gao Y, Ge S, Gao L, Zhang B, Li Z, Zhou W, Wang B, Li L, Tian Q. Efficacy and safety of intravenous nimodipine administration for treatment of hypertension in patients with intracerebral hemorrhage. Neuropsychiatr Dis Treat. 2015;11:1231-1238, https://doi.org/10.2147/NDT.S76882
10. Buchheit F, Boyer P. Review of treatment of symptomatic cerebral vasospasm with nimodipine. Acta Neurochir Suppl (Wien). 1988;45:51-5. doi: 10.1007/978-3-7091-9014-2_8. PMID: 3066142.
11. Mijailovic M, Lukic S, Laudanovic D, Folic M, Folic N, Jankovic S. Effects of nimodipine on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage treated by endovascular coiling. Adv Clin Exp Med. 2013 Jan-Feb;22(1):101-9. PMID: 23468268.
12. Smetana KS, Buschur PL, Owusu-Guha J, May CC. Pharmacologic Management of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. Crit Care Nurs Q. 2020 Apr/Jun;43(2):138-156. doi: 10.1097/CNQ.0000000000000299. PMID: 32084059.
13. Chugh C, Agarwal H. Cerebral vasospasm and delayed cerebral ischemia: Review of literature and the management approach. Neurol India [serial online] 2019 [cited 2022 Apr 3];67:185-200. Available from:
https://www.neurologyindia.com/text.asp?2019/67/1/185/253627
14. Daou BJ, Koduri S, Thompson BG, Chaudhary N, Pandey AS. Clinical and experimental aspects of aneurysmal subarachnoid hemorrhage. CNS Neurosci Ther. 2019;25(10):1096-1112. doi:10.1111/cns.13222
15. Liu, Yf., Qiu, HC., Su, J. et al. Drug treatment of cerebral vasospasm after subarachnoid hemorrhage following aneurysms. Chin Neurosurg Jl 2, 4 (2016). https://doi.org/10.1186/s41016-016-0023-x
Published
2022-08-31
How to Cite
BUSHINOSKA, Jasna M. et al. CONTINUOUS INTRAVENOUS NIMODIPINE APPLICATION FOR PREVENTION OF VASOSPASM BEFORE ENDOVASCULAR TREATMENT OF RUPTURED CEREBRAL ANEURISMS. Journal of Morphological Sciences, [S.l.], v. 5, n. 2, p. 142-149, aug. 2022. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol5no2-20>. Date accessed: 25 sep. 2022.
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Articles