Selective Intra-arterial Infusion Of Nimodipine After Endovascular Treatmnet Of Aneurysms For Treating Cerebral Vasospasm

Purpose: The purpose of the present study was to evaluate the safety andeffectiveness of intra-arterial administration of nimodipine(IAN) afterembolization of aneurysm for treating symptomatic cerebral vasosoasm(CVS);and to study the mechanism of nimodipine for treating CVS by analyzing changesof cerebral circulation time(CCT) and diameters of interest arteries after IAN.Maerterials and Methods:30patients with symptomatic vasospasms due toaneurysmal SAH, who accepted endovascular treatment of cerebral aneurysms,were divided randomly into two groups, as contol group (9patients) andinterventional group (21patients). In9patients of control group,10mlphysiologic saline were infused intra-arterially at a rate of1ml/min afterembolization of cerebral aneurysm. In other21patients in interventionalgroup,2.0mg nimodipine were infused intra-arterially via a microcatheter inthe internal carotid artery at a rate of0.2mg/min after embolization of cerebralaneurysm. Cerebral angiographies were performed respectively before and afterintra-arterial administration of nimodipine or physiologic saline in the30patients. Cerebral circulation time(CCT), peripheral CCT, and the diameters of interestarteries (M1, A1, and M4) were calculated on angiography by using imageprocessing software (sigmascan pro5). The changes of cerebral microcirculationafter the intra-arterial infusion of nimodipine or saline could be assessed bymeasuring CCTs and peripheral CCTs.Results: In21patients of interventional group, CCT and peripheral CCT, were notsignificantly shortened after intra-arterial infusion of nimodipine(IAN), despiteincreasing moderately the diameters of interest arteries, especially distal smallarteries. The outcomes on discharge between contol group and interventionalgroup were not significant differences according to Glasgow OutcomeScale.Conclusion: IAN after embolization of cerebral aneurysms can effectively relaxspastic arteries, despite temporary IAN treatment can’t notably improve cerebralmicrocirculation. Only once IAN treatment after endovascular treatment ofaneurysms can’t improve clinical outcome of aSAH patients. The clinical studyabout relationship between continuous IAN therapy and CCT (especiallyperipheral CCT) possessing enough cases load are warranted.