Effect of intra-arterial and intravenous nimodipine therapy of cerebral vasospasm after SAH on cerebrovascular reactivity and oxygenation.

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Effect of intra-arterial and intravenous nimodipine therapy of cerebral vasospasm after SAH on cerebrovascular reactivity and oxygenation.

World Neurosurg. 2017 Feb 13;:

Authors: Hockel K, Diedler J, Steiner J, Birkenhauer U, Ernemann U, Schuhmann MU

Abstract
BACKGROUND: For the treatment and prevention of delayed cerebral ischemia after subarachnoid hemorrhage the vasodilating agent nimodipine (NDP) is widely employed. This study investigates the effect of NDP on the cerebrovascular autoregulation, assessed by pressure reactivity index (PRx), and brain tissue oxygenation (pbrO2) when given continuous intravenously, as intra-arterial bolus or during continuous intra-arterial therapy.
METHODS: Computerized continuous neuromonitoring-data (ICP, MAP, CPP, pbrO2, PRx) of 105 patients with aneurysmal SAH were retrospectively evaluated. The effect of NDP on all parameters was compared when applied intra-arterially for the treatment of severe macro-vasospasm leading to perfusion deficits either as bolus treatment (n=111 in 37 patients) or as continuous infusion (n=20 patients) to patients without or with only mild macro-vasospasm, who received either intravenous NDP or no NDP at all.
RESULTS: Compared to patients without treatment, the intravenous application of NDP was associated with a significantly higher PRx. Autoregulation was strongly and long lastingly affected (high PRx) in continuous intra-arterial NDP infusion, accompanied by a sustained improvement of pbrO2. Intra-arterial bolus NDP application resulted as well in a significant increase of pbrO2 and PRx; the induced effect, however, was transient and subsided within 6 hours. ICP, MAP, and CPP were not affected during the monitoring period.
CONCLUSION: The pharmacologically induced alteration of the cerebrovascular autoregulation by NDP correlates with changes of pbrO2 and indicates a beneficial effect on cerebral blood flow (CBF) if CPP is maintained. This effect is limited to a few hours after bolus treatment and milder for intravenous compared to intra-arterial application.

PMID: 28232152 [PubMed - as supplied by publisher]

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