米力诺联合尼莫地平反复动脉内治疗严重难治性血管痉挛：自身系列和叙述性文献综述

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine Pub Date : 2025-01-01 DOI:10.1016/j.bas.2025.104260

Bernhard Wambacher , Julia Kappel , Joachim Vavrik , Michel Loyoddin , Martin Ortler , Camillo Sherif

{"title":"米力诺联合尼莫地平反复动脉内治疗严重难治性血管痉挛：自身系列和叙述性文献综述","authors":"Bernhard Wambacher , Julia Kappel , Joachim Vavrik , Michel Loyoddin , Martin Ortler , Camillo Sherif","doi":"10.1016/j.bas.2025.104260","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebral vasospasm (VSP) following aneurysmal subarachnoid hemorrhage remains a major source of morbidity. The best rescue treatment option remains uncertain. Intraarterial (ia) Milrinone and Nimodipine were suggested as safe treatment options.</div></div><div><h3>Research question</h3><div>We aimed to evaluate the effect of repetitive endovascular intraarterial (ia) combined Milrinone and Nimodipine administration as rescue therapy for severe refractory cerebral VSP.</div></div><div><h3>Material & methods</h3><div>In this retrospective single center series, we included only patients with refractory VSP despite maximum standard conservative therapy. Inclusion criteria for endovascular rescue treatment were elevated transcranial Doppler (TCD) > 180 cm/s and/or significant clinical neurological deterioration. Patients received ia therapy with Nimodipine 2 mg followed by Milrinone 5 mg. Repetitive reinterventions were indicated in cases of refractory VSP. We evaluated pre- and direct posttreatment neurological status, mRS at final clinical follow-up, TCD values and measured the DSA pre-postinterventional vessel diameters.</div></div><div><h3>Results</h3><div>38 aSAH patients received ia therapy. Of those, 18 patients (47.4 %) received ≥3 interventions (average:3.4 ± 2.6; maximum:11). Immediate improvement of neurological deficits was seen in 31/38 patients (81.6 %). Overall mortality was low (3/38, 7.9 %). The clinical follow-up after 4 months showed persistent improvement in 24/38 patients (63.2 %) with good clinical outcomes (mRS ≤3). Immediate postinterventional angiographic improvement of vessel diameter was shown in 97,7 % (127/130) of all interventions. Neither severe cardiovascular nor reintervention-related adverse events were observed.</div></div><div><h3>Discussion and conclusion</h3><div>In this series repetitive ia interventions combining Milrinone and Nimodipine showed promising clinical results and low mortality for refractory VSP. Larger prospective randomized clinical trials are warranted.</div></div><div><h3>Trial registration</h3><div>ISRCTN, study ID ISRCTN36126862 registered 21.11.2018, retrospectively registered, <span><span>http://www.isrctn.com/ISRCTN36126862</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104260"},"PeriodicalIF":1.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Repetitive intraarterial therapy with Milrinone and Nimodipine for severe refractory Vasospasm: own series and narrative literature review\",\"authors\":\"Bernhard Wambacher , Julia Kappel , Joachim Vavrik , Michel Loyoddin , Martin Ortler , Camillo Sherif\",\"doi\":\"10.1016/j.bas.2025.104260\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Cerebral vasospasm (VSP) following aneurysmal subarachnoid hemorrhage remains a major source of morbidity. The best rescue treatment option remains uncertain. Intraarterial (ia) Milrinone and Nimodipine were suggested as safe treatment options.</div></div><div><h3>Research question</h3><div>We aimed to evaluate the effect of repetitive endovascular intraarterial (ia) combined Milrinone and Nimodipine administration as rescue therapy for severe refractory cerebral VSP.</div></div><div><h3>Material & methods</h3><div>In this retrospective single center series, we included only patients with refractory VSP despite maximum standard conservative therapy. Inclusion criteria for endovascular rescue treatment were elevated transcranial Doppler (TCD) > 180 cm/s and/or significant clinical neurological deterioration. Patients received ia therapy with Nimodipine 2 mg followed by Milrinone 5 mg. Repetitive reinterventions were indicated in cases of refractory VSP. We evaluated pre- and direct posttreatment neurological status, mRS at final clinical follow-up, TCD values and measured the DSA pre-postinterventional vessel diameters.</div></div><div><h3>Results</h3><div>38 aSAH patients received ia therapy. Of those, 18 patients (47.4 %) received ≥3 interventions (average:3.4 ± 2.6; maximum:11). Immediate improvement of neurological deficits was seen in 31/38 patients (81.6 %). Overall mortality was low (3/38, 7.9 %). The clinical follow-up after 4 months showed persistent improvement in 24/38 patients (63.2 %) with good clinical outcomes (mRS ≤3). Immediate postinterventional angiographic improvement of vessel diameter was shown in 97,7 % (127/130) of all interventions. Neither severe cardiovascular nor reintervention-related adverse events were observed.</div></div><div><h3>Discussion and conclusion</h3><div>In this series repetitive ia interventions combining Milrinone and Nimodipine showed promising clinical results and low mortality for refractory VSP. Larger prospective randomized clinical trials are warranted.</div></div><div><h3>Trial registration</h3><div>ISRCTN, study ID ISRCTN36126862 registered 21.11.2018, retrospectively registered, <span><span>http://www.isrctn.com/ISRCTN36126862</span><svg><path></path></svg></span>.</div></div>\",\"PeriodicalId\":72443,\"journal\":{\"name\":\"Brain & spine\",\"volume\":\"5 \",\"pages\":\"Article 104260\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brain & spine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772529425000797\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain & spine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772529425000797","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

动脉瘤性蛛网膜下腔出血后脑血管痉挛（VSP）仍然是发病率的主要来源。最好的抢救治疗方案仍不确定。建议动脉注射米力农和尼莫地平作为安全的治疗选择。研究问题：我们旨在评价米力农联合尼莫地平重复血管内动脉内（ia）治疗严重难治性脑VSP的疗效。材料,方法在这个回顾性单中心系列研究中，我们只纳入了难治性VSP患者，尽管采用了最大标准保守治疗。血管内抢救治疗纳入标准：经颅多普勒（TCD）升高；180 cm/s和/或明显的临床神经退化。患者先用尼莫地平2mg，再用米力农5mg。在难治性VSP病例中，需要重复的再干预。我们评估了治疗前和直接治疗后的神经系统状态、最终临床随访时的mRS、TCD值，并测量了介入前和介入后的血管直径。结果38例aSAH患者接受了ia治疗。其中，18例患者（47.4%）接受了≥3次干预(平均：3.4±2.6；最大:11)。38例患者中有31例（81.6%）的神经功能缺损立即得到改善。总体死亡率较低（3/38,7.9%）。临床随访4个月后，24/38例（63.2%）患者持续改善，临床效果良好（mRS≤3）。在所有干预措施中，97.7%（127/130）的介入后血管造影显示血管直径立即改善。没有观察到严重的心血管或再干预相关的不良事件。讨论与结论米力农联合尼莫地平治疗难治性VSP具有良好的临床效果和低死亡率。更大规模的前瞻性随机临床试验是必要的。试验注册号isrctn，研究编号ISRCTN36126862，注册日期为2018年11月21日，回顾性注册，http://www.isrctn.com/ISRCTN36126862。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Repetitive intraarterial therapy with Milrinone and Nimodipine for severe refractory Vasospasm: own series and narrative literature review

Introduction

Cerebral vasospasm (VSP) following aneurysmal subarachnoid hemorrhage remains a major source of morbidity. The best rescue treatment option remains uncertain. Intraarterial (ia) Milrinone and Nimodipine were suggested as safe treatment options.

Research question

We aimed to evaluate the effect of repetitive endovascular intraarterial (ia) combined Milrinone and Nimodipine administration as rescue therapy for severe refractory cerebral VSP.

Material & methods

In this retrospective single center series, we included only patients with refractory VSP despite maximum standard conservative therapy. Inclusion criteria for endovascular rescue treatment were elevated transcranial Doppler (TCD) > 180 cm/s and/or significant clinical neurological deterioration. Patients received ia therapy with Nimodipine 2 mg followed by Milrinone 5 mg. Repetitive reinterventions were indicated in cases of refractory VSP. We evaluated pre- and direct posttreatment neurological status, mRS at final clinical follow-up, TCD values and measured the DSA pre-postinterventional vessel diameters.

Results

38 aSAH patients received ia therapy. Of those, 18 patients (47.4 %) received ≥3 interventions (average:3.4 ± 2.6; maximum:11). Immediate improvement of neurological deficits was seen in 31/38 patients (81.6 %). Overall mortality was low (3/38, 7.9 %). The clinical follow-up after 4 months showed persistent improvement in 24/38 patients (63.2 %) with good clinical outcomes (mRS ≤3). Immediate postinterventional angiographic improvement of vessel diameter was shown in 97,7 % (127/130) of all interventions. Neither severe cardiovascular nor reintervention-related adverse events were observed.

Discussion and conclusion

In this series repetitive ia interventions combining Milrinone and Nimodipine showed promising clinical results and low mortality for refractory VSP. Larger prospective randomized clinical trials are warranted.