Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm

Objective: Endovascular chemical angioplasty has been in practice in patients with symptomatic cerebral vasospasm secondary to aneurysmal subarachnoid haemorrhage in many neurosurgical centres. However, the evidence base is derived from clinical case series and expert consensus. The aim of this retr...

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Autores principales:	Hannah Woodford, Michael Taylor, Behzad Eftekhar, Richard Waugh, Joga Chaganti
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	aSAH Cerebral vasospasm Intra-arterial calcium channel blockers Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/566652d9296a45729b08a88e30268537
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spelling	oai:doaj.org-article:566652d9296a45729b08a88e302685372021-11-28T04:32:29ZDual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm2214-751910.1016/j.inat.2021.101442https://doaj.org/article/566652d9296a45729b08a88e302685372022-03-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214751921003546https://doaj.org/toc/2214-7519Objective: Endovascular chemical angioplasty has been in practice in patients with symptomatic cerebral vasospasm secondary to aneurysmal subarachnoid haemorrhage in many neurosurgical centres. However, the evidence base is derived from clinical case series and expert consensus. The aim of this retrospective cohort study is to evaluate the immediate and functional outcomes of endovascular intervention in aneurysmal subarachnoid haemorrhage cerebral vasospasm treated with a combination of vasodilators. Methods: A cohort of 25 patients was identified. Each patient underwent surgical clipping, and endovascular treatment for vasospasm. A combination of Verapamil and Nimodipine was intra-arterially administered. Statistical analysis was performed to determine the rate of response. The angiographic response and functional outcome on discharge (modified Rankin score - MRS) were used as markers of outcome. Results: The study cohort consisted of 25 patients with a mean age of 50.3 (SD 11.2). A total of 135 therapeutic DSA’s were performed. There was an associated between MRS outcomes and number of vasodilation’s each patient received. For each additional vasodilation episode, the odds of a poor outcome increased by 1.190. An angiographic response was demonstrated in 88% of patients, a clinical response in 27%. A good functional outcome was achieved in 17/25, 71% at discharge. Conclusion: The combination therapy of Intra-arterial nimodipine and verapamil in patients with aneurysmal subarachnoid haemorrhage vasospasm appears to have a synergistic, if not comparable, outcome to from solitary vasodilatory treatment results and potentially promote future studies with prospective designs to measure the outcomes.Hannah WoodfordMichael TaylorBehzad EftekharRichard WaughJoga ChagantiElsevierarticleaSAHCerebral vasospasmIntra-arterial calcium channel blockersSurgeryRD1-811Neurology. Diseases of the nervous systemRC346-429ENInterdisciplinary Neurosurgery, Vol 27, Iss , Pp 101442- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	aSAH Cerebral vasospasm Intra-arterial calcium channel blockers Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429
spellingShingle	aSAH Cerebral vasospasm Intra-arterial calcium channel blockers Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429 Hannah Woodford Michael Taylor Behzad Eftekhar Richard Waugh Joga Chaganti Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm
description	Objective: Endovascular chemical angioplasty has been in practice in patients with symptomatic cerebral vasospasm secondary to aneurysmal subarachnoid haemorrhage in many neurosurgical centres. However, the evidence base is derived from clinical case series and expert consensus. The aim of this retrospective cohort study is to evaluate the immediate and functional outcomes of endovascular intervention in aneurysmal subarachnoid haemorrhage cerebral vasospasm treated with a combination of vasodilators. Methods: A cohort of 25 patients was identified. Each patient underwent surgical clipping, and endovascular treatment for vasospasm. A combination of Verapamil and Nimodipine was intra-arterially administered. Statistical analysis was performed to determine the rate of response. The angiographic response and functional outcome on discharge (modified Rankin score - MRS) were used as markers of outcome. Results: The study cohort consisted of 25 patients with a mean age of 50.3 (SD 11.2). A total of 135 therapeutic DSA’s were performed. There was an associated between MRS outcomes and number of vasodilation’s each patient received. For each additional vasodilation episode, the odds of a poor outcome increased by 1.190. An angiographic response was demonstrated in 88% of patients, a clinical response in 27%. A good functional outcome was achieved in 17/25, 71% at discharge. Conclusion: The combination therapy of Intra-arterial nimodipine and verapamil in patients with aneurysmal subarachnoid haemorrhage vasospasm appears to have a synergistic, if not comparable, outcome to from solitary vasodilatory treatment results and potentially promote future studies with prospective designs to measure the outcomes.
format	article
author	Hannah Woodford Michael Taylor Behzad Eftekhar Richard Waugh Joga Chaganti
author_facet	Hannah Woodford Michael Taylor Behzad Eftekhar Richard Waugh Joga Chaganti
author_sort	Hannah Woodford
title	Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm
title_short	Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm
title_full	Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm
title_fullStr	Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm
title_full_unstemmed	Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm
title_sort	dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/566652d9296a45729b08a88e30268537
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Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm

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