Evidence-Based Approach to Cerebral Vasospasm and Delayed Cerebral Ischemia: Milrinone as a Therapeutic Option-A Narrative Literature Review and Algorithm Treatment Proposition.

IF 3.2 Q2 CLINICAL NEUROLOGY

Neurology International Pub Date : 2025-02-21 DOI:10.3390/neurolint17030032

Pedro Batarda Sena, Marta Gonçalves, Bruno Maia, Margarida Fernandes, Luís Bento

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Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurocritical condition often complicated by cerebral vasospasm (CVS), leading to delayed cerebral ischemia (DCI) and significant morbidity and mortality. Despite advancements in management, therapeutic options with robust evidence remain limited. Milrinone, a phosphodiesterase type 3 (PDE3) inhibitor, has emerged as a potential therapeutic option. Intravenous milrinone demonstrated clinical and angiographic improvement in 67% of patients, reducing the need for mechanical angioplasty and the risk of functional disability at 6 months (mRS ≤ 2). Side effects, including hypotension, tachycardia, and electrolyte disturbances, were observed in 33% of patients, occasionally leading to early drug discontinuation. Based on the evidence, we propose a treatment algorithm for using milrinone to optimize outcomes and standardize its application in neurocritical care settings.

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脑血管痉挛和迟发性脑缺血的循证治疗方法：米力农作为一种治疗选择——叙述性文献综述和算法治疗主张。

动脉瘤性蛛网膜下腔出血（aSAH）是一种严重的神经危重症，常并发脑血管痉挛（CVS），导致迟发性脑缺血（DCI）和显著的发病率和死亡率。尽管在管理方面取得了进步，但具有有力证据的治疗选择仍然有限。米立酮是一种磷酸二酯酶3型（PDE3）抑制剂，已成为一种潜在的治疗选择。静脉注射米力农改善了67%的患者的临床和血管造影，减少了机械血管成形术的需要和6个月时功能残疾的风险（mRS≤2）。33%的患者出现低血压、心动过速和电解质紊乱等副作用，偶尔会导致早期停药。基于这些证据，我们提出了一种使用米林酮的治疗算法，以优化结果并规范其在神经危重症护理环境中的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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