Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2013, vol. 22, nr 1, January-February, p. 101–109

Publication type: original article

Language: English

Effects of Nimodipine on Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage Treated by Endovascular Coiling

Wpływ nimodypiny na skurcz naczyń mózgowych u chorych z krwotokiem podpajęczynówkowym z pękniętego tętniaka leczonych przez embolizację wewnątrznaczyniową

Milan Mijailovic1,A,D,E,F, Snezana Lukic1,A,D,E,F, Dragomir Laudanovic2,B,C,F, Marko Folic3,C,D,E,F, Nevena Folic3,C,D,E,F, Slobodan Jankovic3,A,C,D,E,F

1 Radiology Department, Medical Faculty, University of Kragujevac and Kragujevac Clinical Center, Kragujevac, Serbia

2 Radiology Department, City Hospital, Uzice, Serbia

3 Pharmacology Department, Medical Faculty, University of Kragujevac and Kragujevac Clinical Center, Kragujevac, Serbia

Abstract

Background. An aneurysmal subarachnoid hemorrhage could be complicated with cerebral vasospasm and resultant ischemia, causing neurological deficit.
Objectives. The aim of this study was to compare early and late outcomes in patients with subarachnoidal hemorrhage (SAH) treated by endovascular coiling, who either received or did not receive prophylaxis of cerebral vasospasm with nimodipine.
Material and Methods. In this retrospective cross-sectional study, the data was collected from the histories of 68 patients (38 females and 30 males, age range 29–71 years) with spontaneous aneurysmal SAH in clinical stage HH I–IV, treated at Kragujevac Clinical Center, Serbia, from January 2008 till June 2009. The study population was divided into two groups: (1) the group of 42 patients who received intravenous prophylaxis with nimodipine for 3 weeks, and (2) the group of 26 patients who did not receive nimodipine prophylaxis.
Results. Prophylactic use of nimodipine did not decrease the rate of neurological deficit after one month, but the rates of both cerebral vasospasm (symptomatic and asymptomatic) and the morphological signs of ischemia using nuclear magnetic resonance imaging (MRI) were significantly lower in the nimodipine-protected group. Cerebral vasospasm was detected by Digital Subtraction Angiography (DSA) in the group protected by nimodipine as discrete in 2 patients (5%), and as apparent in 0 patients (0%). On the other hand, in the group unprotected by nimodipine, cerebral vasospasm was detected by DSA as discrete in 9 patients (35%), and as apparent in 6 patients (23%). Up to one month after the endovascular coiling, in the nimodipine-protected group, the T1W hypointense zones were detected by MRI as “small” in 5 patients (12%), as “medium” in 1 patient (2.5%), as “large” in 1 patient (2.5%), and as “multiple” in 2 patients (5%). In the nimodipine-unprotected group, the T1W hypointense zones were detected by MRI as “small” in 4 patients (16%), as “medium” in 2 patients (8%), as “large” in 3 patients (12%), and as “multiple” in 4 patients (16%). The difference between the groups was significant.
Conclusion. When a patient with SAH is treated with the endovascular clipping procedure, prophylactic administration of nimodipine is mandatory due to the reduced rate of cerebral vasospasm and delayed cerebral ischemia.

Streszczenie

Wprowadzenie.Krwotok podpajęczynówkowy może być powikłany skurczem naczyń mózgowych i następującym niedokrwieniem, co powoduje deficyt neurologiczny.
Cel pracy. Porównanie wyników wczesnych i odległych u chorych z krwotokiem podpajęczynówkowym (SAH) leczonych przez embolizację wewnątrznaczyniową, którzy otrzymali lub nie otrzymywali nimodypinę jako profilaktykę skurczu naczyń mózgowych.
Materiał i metody. W tym retrospektywnym badaniu przekrojowym zebrano historie 68 pacjentów (38 kobiet i 30 mężczyzn, w wieku 29–71 lat) ze spontanicznym krwotokiem podpajęczynówkowym z pękniętego tętniaka w klinicznym stadium HH I-IV, leczonych w Centrum Klinicznym w Kragujevac, Serbia, od stycznia 2008 do czerwca 2009 roku. Badanych podzielono na dwie grupy: (1) grupa 42 pacjentów, którzy otrzymywali dożylnie profilaktycznie nimodypinę przez 3 tygodnie i (2) grupa 26 pacjentów, którzy nie otrzymywali nimodypiny.
Wyniki. Profilaktyczne stosowanie nimodypiny nie zmniejszyło odsetka deficytu neurologicznego po miesiącu, ale częstotliwość zarówno skurczu naczyń mózgowych (objawowego i bezobjawowego), jak i morfologicznych objawów niedokrwienia w badaniu MRI były istotnie mniejsze w grupie, w której podawano nimodypinę. Skurcz naczyń mózgowych został wykryty za pomocą badania DSA w grupie, w której podawano nimodypinę jako nieciągły u 2 (5%), i jako widoczny u 0 pacjentów (0%). Z drugiej strony, w grupie bez podawania nimodypiny, skurcz naczyń mózgowych wykryto za pomocą metody DSA jako nieciągły u 9 pacjentów (35%), i widoczny u 6 pacjentów (23%). W ciągu jednego miesiąca po embolizacji wewnątrznaczyniowej w grupie, w której podawano nimodypinę hipointensywne obszary T1W zostały wykryte w badaniu MR jako „małe” u 5 chorych (12%), jako „średnie” u 1 chorego (2,5%), jako „duże” u 1 (2,5%), jako „liczne” u 2 (5%). W grupie bez podawania nimodypiny, hipointensywne obszary T1W wykryte w badaniu MR jako „małe” u 4 (16%), jako „średnie” u 2 (8%), jako „duże” u 3 (12%), i jako „liczne” u 4 chorych (16%). Różnica między grupami była istotna statystycznie.
Wnioski. Kiedy pacjent z krwotokiem podpajęczynówkowym jest leczony za pomocą embolizacji wewnątrznaczyniowej, profilaktyczne podawanie nimodypiny jest obowiązkowe ze względu na zmniejszenie ryzyka skurczu naczyń mózgowych i opóźnianie niedokrwienia mózgu.

Key words

subarachnoidal hemorrhage, endovascular coiling, cerebral vasospasm, nimodipine.

Słowa kluczowe

krwotok podpajęczynówkowy, embolizacja wewnątrznaczyniowa, skurcz naczyń mózgowych, nimodypina.

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