Endovascular treatment of cerebral vasospasm with intraarterial injection of verapamil and nimodipine. single center experience

Mikeladze, K.; Vinogradov, E.; Konovalov, A.; Okishev, D.; Artemiev, A.; Yakovlev, S.

Авторы: Mikeladze K., Vinogradov E., Konovalov A., Okishev D., Artemiev A., Yakovlev S.
Сборник: SNIS 20th annual meeting electronic poster abstracts
Тезисы
Год издания: 2023
Издательство: BMJ Publishing Group Ltd
Местоположение издательства: [London], England
Номер статьи: E-253
DOI: 10.1136/jnis-2023-snis.352
Аннотация: AbstractIn the period from 2017 to 2023 at the N. N. Burdenko Institute of Neurosurgery intraarterial injection of verapamil and nimodipine for treatment of cerebral spasm was performed in 100 patients. More than 300 procedures were preformed after closing a ruptured aneurysm in the acute stage of SAH. Age of patients - from 12 to 79 years. 74 patients with Hunt-Hesse score more than 3. Efficacy of intervention was evaluated by the administration of transcranial Doppler ultrasound and clinically by modified Rankin scale. Multiple treatments (2-12 times). Dynamic selection of a dose (25-150 mg). The degree of spasm was determined angiographically. According to the degree of spasm: mild - up to 30%, moderate - 30-60%, severe - 60-100%. Angiographic spasm of the vessel was calculated in percentage relative to the standard average size for the internal carotid artery on both sides, 4 mm; for the middle cerebral artery on both sides, 3.2 mm; for the larger anterior cerebral artery, 2.6 mm; and for the main artery, 3 mm. Dosage was selected accordingly. We had 4 patients with prolonged verapamil/nimodipine infusion (more than 1 day); out of 4 patients 2 developed complications: thromboembolic event, displacement of microcatheter; in two cases the treatment was successful. Treatment outcomes were analyzed for all 100 patients. At the time of discharge, only 48% (48 people) had favorable outcomes (Rankin 1-3). In the long term (after the third month of observation), most patients were compensated, and favorable outcomes were noted in 74.3% New ischemic foci (delayed ischemia) after starting the IAV course occurred in 13 cases (31%) .Of the seven patients who died, only one died due to the progression of angiospasm, while the IAV course in this case was started only after the appearance of an ischemic focus due to the progression of angiospasm. Causes of death of three other patients were postoperative ischemic changes, exacerbation of severe somatic pathology. When comparing outcomes with different parameters, clinically relevant facts were identified. There was no correlation between the immediate and distant outcomes with the severity of the condition on the Hunt-Hess scale upon admission. It should be noted that none of the 11 patients with the Hunt-Hess score ‘5’ died. Out of 35 patients with a Hunt-Hess score of 4-5, in the long-term period, only 7 patients had adverse outcomes (mRs 4-6). Conclusion: Endovascular administration of verapamil and nimodipine for treatment of cerebral vasospasm is a safe technique (procedure-related complications - 3.6%), which allows to achieve a decrease in blood flow velocity (effect of injection is short-lived) and positively affects the overall recovery of such patients, including patients with the severity of H-H 4.5. Despite the successful effect with the severe group of patients, careful consideration of the ethical side is necessary.Disclosures K. Mikeladze: None. E. Vinogradov: None. A. Konovalov: None. D. Okishev: None. A. Artemiev: None. S. Yakovlev: None.http://dx.doi.org/10.1136/jnis-2023-SNIS.352
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