Efficacy of combined intravenous plus intrathecal nimodipine administration in patients with severe cerebral vasospasm post‑aneurysmal subarachnoid hemorrhage: A retrospective cohort study

Faropoulos,Konstantinos; Tsolaki,Vasiliki; Georgakopoulou,Vasiliki Epameinondas; Trakas,Ilias; Tarantinos,Kyriakos; Papalexis,Petros; Spandidos,Demetrios A.; Aravantinou‑Fatorou,Aikaterini; Mathioudakis,Nikolaos; Trakas,Nikolaos; Fotakopoulos,George

doi:10.3892/mi.2022.63

Efficacy of combined intravenous plus intrathecal nimodipine administration in patients with severe cerebral vasospasm post‑aneurysmal subarachnoid hemorrhage: A retrospective cohort study

Authors:
- Konstantinos Faropoulos
- Vasiliki Tsolaki
- Vasiliki Epameinondas Georgakopoulou
- Ilias Trakas
- Kyriakos Tarantinos
- Petros Papalexis
- Demetrios A. Spandidos
- Aikaterini Aravantinou‑Fatorou
- Nikolaos Mathioudakis
- Nikolaos Trakas
- George Fotakopoulos
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Affiliations: Department of Neurosurgery, Nicosia General Hospital, 2029 Nicosia, Cyprus, Department of Pulmonary and Critical Care Medicine, General University Hospital of Larisa, 41221 Larisa, Greece, Department of Infectious Diseases‑COVID‑19 Unit, Laiko General Hospital, 11527 Athens, Greece, First Department of Pulmonology, Sismanogleio Hospital, 15126 Athens, Greece, Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece, Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece, Renal Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece, Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece, Department of Neurosurgery, General University Hospital of Larisa, 41221 Larisa, Greece
Published online on: December 16, 2022 https://doi.org/10.3892/mi.2022.63
Article Number: 3
Copyright: © Faropoulos et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) and the ensuing cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) comprise the main reasons for morbidity and mortality in affected patients. The present study aimed to evaluate the efficacy of the use of combined intravenous (IV) and intrathecal (IT) nimodipine therapy for preventing permanent neurological deterioration and DCI in patients suffering from CV post‑hemorrhage. The evaluation was performed using computed tomography perfusion and transcranial doppler ultrasound. The present retrospective cohort study analyzed 14 out of 146 patients diagnosed with vasospasm due to spontaneous or aSAH. These patients were divided into two groups as follows: i) The IV group, which included patients treated with only IV nimodipine; and ii) the IV + IT group, which included patients who received IV nimodipine in combination with IT nimodipine. Of the 14 patients, 7 patients were males (50%), and the mean age was 50.9 years (SD ±19 years). In total, 6 patients [42.8%; 5 (35.7%) from group A and 1 (7.1%) from group B], who experienced clinical symptoms with severe CV, were administered intra‑arterial calcium channel therapy or/and IT nimodipine following the early identification of symptomatic vasospasm. The rate of adverse ischemic events was lower with IT nimodipine management during the 1 month of follow‑up (6 vs. 2 events; odds ratio, 15.00; 95% confidence interval, 1.03‑218.31; P=0.031). On the whole, the findings of the present study suggest that the combined use of IT nimodipine with IV admission for patients post‑aSAH who developed severe CV is a safe procedure that may prevent permanent neurological deterioration and delay unfavorable ischemic incidents.

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