Document resource
Purpose Angiographic Vasospasm is one of the leading causes of preventable poor outcome after aneurysmal subarachnoid hemorrhage (SAH) with an overall incidence of 50~90%. Chemical angioplasty with intra-arterial injection of vasodilators is a potent intervention for medically refractory vasospasm. However, the efficacy of the procedure is temporary maintained. Continuous intra-arterial nimodipine infusion (CIN) can be considered for severe diffuse vasospasm which is combined with impairment of micro-perfusion.Materials and Methods Total 273 patients with aneurysmal SAH were included from March 2018 to February 2024. Among them, 14 patients (5.1%) were underwent chemical angioplasty due to neurologic deterioration or perfusion delay on computed tomography despites of medical therapy. Five patients (1.8%) who did not show angiographic improvement on digital subtraction angiography (DSA) and neurological deficit received CIN. Microcatheter was located near the most spastic parent artery or distal internal carotid artery and continuous administration (0.4~2mg/h) of nimodipine was maintained for 21~81 hours. Simultaneously heparin (3000 IU/L, 20ml/h) infusion through the guiding catheter was also performed to prevent thrombus apposition related with devices. Hypervolemia and induced hypertension therapy were combined with plasma volume expander and inotropic agents.Results Median onset of CIN was 8 days after aneurysmal SAH and median duration was 53 hours. Post-CIN DSA showed improvement in vasospasm-affected parent artery and perfusion study showed improved diffuse cerebral perfusion. Functional outcome with modified Rankin scale at discharge was 0~3, showing much improved neurologic symptoms. However, minor cerebral infarction (< 1/3 of large vessel vasospasm-affected territory) occurred in all patients. Among them, 1 patient developed heparin-induced thrombocytopenia and had to discontinue CIN inadvertently.Conclusion In cases of medically refractory severe diffuse vasospasm after aneurysmal SAH, repeat chemical angioplasty is required. CIN can be considered to alternative effective intervention. Furthermore, it has the advantage of longer duration with vasodilator effect compared with single session injection of chemical angioplasty.Disclosures Y. Chung: None.