Introduction: Severe cerebral vasospasm is a major complication after subarachnoid hemorrhage. When traditional treatment options fail the continuous intraarterial application of Nimodipine can be used as last resort. We use this treatment regularly and were interested in the instant as well as the ongoing impact of continuous intraarterial Nimodipine appplication on cerebral blood flow in patients with severe vasospasm. To gather this information we used the the Hemedex monitoring system to continuously measure cbf during the nimodipine application.
Methods: In patients with severe vasospasm revealed by transcranial doppler and PtiO2 or cerebral oxygen saturation measurement continuous cbf monitoring using the Hemedex probe was implanted and a cerebral angiography was performed. In case of severe vasospasm a catheter was placed in the carotid artery and a continuous Nimodipine infusion was started with 1 mg/h. Treatment was continued for up to three days depending on the control angiographies. The Hemedex was used to measure impact of the treament during and after the procedure.
Results: All patients showed a significant and rapid rise in cerebral blood flow early after starting of Nimodipine infusion. They reached a steady state after about 15 minutes and after that we saw a decline in blood flow but CBF levels stayed above baseline. In some patients the intervention was succesful leading to a complete reversion of the vasopsoasm as shown by transcranial doppler or angiography. None of the patients suffered severe complication such as vessel lesion or embolic infarction.
Conclusions: With the present preliminary study we could clearly show that the use of continuous intraarterial Nimodipine application is save and efficiant for patients with severe vasospasm after sah when other therapy options fail. The Hemedex monitoring is save to use and is a helpful tool for the neurointesivist to guide the therapy of those patients.
Patient Care: Continuous monitoring of cerebral blood flow is a helpful tool to guide the therapy of cererbal vasospasm. The intraarterial application of Nimodinpine can reduce vasospasm significantly and is save to use.
Learning Objectives: After this session the participants should be able to discuss the latest treatment options of cerebral vasospasm. THey should know how intraarterial Nimodipine appication is performed and that it is a save an efficient treatment option for patients with severe cerebal vasospasm.