Item type: | Article | ||||
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Journal or Publication Title: | Journal of Clinical Neuroscience | ||||
Publisher: | Elsevier | ||||
Place of Publication: | OXFORD | ||||
Volume: | 96 | ||||
Page Range: | pp. 163-171 | ||||
Date: | 2022 | ||||
Institutions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Lehrstuhl für Neurochirurgie Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Klinische Studien Medicine > Zentrum für Neuroradiologie | ||||
Identification Number: |
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Keywords: | DECOMPRESSIVE HEMICRANIECTOMY; CLINICAL-COURSE; MANAGEMENT; PAPAVERINE; EXPERIENCE; INJECTION; ISCHEMIA; THERAPY; Continuous intra-arterial nimodipine; infusion (CIAN); Intra-arterial nimodipine infusion; Cerebral vasospasm; subarachnoid hemorrhage (SAH); delayed cerebral ischemia (DCI); Outcome | ||||
Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
Status: | Published | ||||
Refereed: | Yes, this version has been refereed | ||||
Created at the University of Regensburg: | Yes | ||||
Item ID: | 57033 |
Abstract
Severe refractory cerebral vasospasm (CV) is a major cause of disability and death in patients with aneurysmal subarachnoid hemorrhage (SAH). One rescue therapy in selected patients is intra-arterial nimodipine, either given as a single shot or as continuous infusion. To evaluate treatment efficacy, we analyzed outcome factors such as the incidence of craniectomy, ventriculo-peritonial (VP) ...
Abstract
Severe refractory cerebral vasospasm (CV) is a major cause of disability and death in patients with aneurysmal subarachnoid hemorrhage (SAH). One rescue therapy in selected patients is intra-arterial nimodipine, either given as a single shot or as continuous infusion. To evaluate treatment efficacy, we analyzed outcome factors such as the incidence of craniectomy, ventriculo-peritonial (VP) shunting, and tracheotomy after intra-arterial nimodipine infusion. We retrospectively analyzed the rates of cerebral infarction, decompressive craniectomy, VP shunting, and tracheotomy in patients with severe CV after SAH. Three different patient groups were compared: group 1 had only been treated with oral nimodipine and hypervolemic hypertensive therapy (HHT) (2006-2010), group 2 with a single shot of intra-arterial nimodipine (SSN) in addition to oral conservative treatment (2006-2010), and group 3 with continuous intra-arterial nimodipine (CIAN) (2011-2017). The incidence of cerebral infarction was significantly lower in CIAN group (p = 0.005) than in conservative and SSN group. The indication for consecutive decompressive craniectomy was significantly lower in CIAN group in comparison with the conservative group (p = 0.018). The rates of VP shunting and tracheotomy were significantly higher in the CIAN group than in the conservative group (p = 0.028 for VP, and p = 0.003 for tracheotomy). The significantly lower rate of craniectomy in the CIAN group was most probably attributable to the significantly lower rate of CV-induced infarction. The higher rate of tracheotomy reflects more extensive sedation and the need of longer stays on the intensive care unit. Thus, the effect on long-term neurological outcome and quality of life has to be evaluated separately. (c) 2021 Elsevier Ltd. All rights reserved.
Metadata last modified: 29 Feb 2024 12:47