Introduction: The goal of this study was to determine whether there is a change in arterial diameter after intraarterial milrinone infusion for cerebral vasospasm secondary to subarachnoid haemorrhage (SAH).
Methods: We retrospectively reviewed the procedure reports, clinical charts, CT and angiograms of patients with symptomatic cerebral vasospasm after SAH. Eight independent radiologists reviewed angiograms of cerebral vessels treated (or not) by intraarterial infusion of milrinone. The arterial diameter assessment was done in a blinded manner. . The study group included arteries that received milrinone with or without balloon angioplasty. Controls corresponded to arteries diagnosed with or without vasospasm and that did not receive milrinone. Changes in the arterial diameter were coded as 1. Changes in arterial diameter were pooled and compared for all reviewers.
Results: Twenty-one patients underwent angiograms for symptomatic vasospasm after SAH between October 2004 and August 2006. Nine cerebral arteries treated with intraarterial milrinone and nine control arteries were assessed for the arterial diameter change. Improved arterial diameter was significantly more often seen (p<0.0001) in arteries after addition of milrinone (65/72, 90%) than in controls (8/72, 11%).
Conclusions: Intraarterial milrinone improves angiographic vasospasm after SAH. However, how long this effect persists is still unknown. Further prospective studies are warranted to asses the effect of milrinone on intracranial artery diameter as well as its clinical impact.
Patient Care: Using a rigorous methodology, this study showed that injection of intraarterial milrinone on patients with symptomatic vasospasm increasses significatively the diameter of cerebral arteries. This clear demonstration about the cerebral vasodilatory properties of milrinone reinforces the idea that the use of intraarterial milrinione may be indicated to treat symptomatic cerebral vasospasm in some cases. Furtheremore,it may represents a rational behind witch building a randomized clinical study.
Learning Objectives: By the conclusion of this session, participants should be able to: 1.
Describe the pathophysiology of cerebral vasospasm. 2. The
morbidity and mortality associated with cerebral vasospasm. 3.
The standard treatment of cerebral vasospasm. 4. Resume and
critics the literature about cerebral vasospasm. 5. Describe the indications of angioplasty for cerebral vasospasm.