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<meta name="DC.Title" content="Continuous Intra-Arterial Infusion of Nimodipine During Embolization of Cerebral Aneurysms Associated With Vasospasm" />
<meta name="DC.Identifier" content="10.3174/ajnr.A0830" />
<meta name="DC.Date" content="2008-02-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Despite rigorous efforts, cerebral vasospasm remains an important cause of morbidity and mortality in patients who survive their initial subarachnoid hemorrhage. In cases of intracranial ruptured aneurysm associated with vasospasm, we evaluated the effectiveness of combined embolization of an aneurysm and intra-arterial infusion of nimodipine, which continued during the entire procedure.

Materials and METHODS: Ten patients with ruptured aneurysms associated with vasospasm who were treated in a single session were reviewed retrospectively. After initial intra-arterial infusion of nimodipine (1–2 mg within 10–15 minutes), they underwent occlusion of the aneurysm with coils under continuous intra-arterial infusion of nimodipine at a dose of 1 mg per hour.

RESULTS: Angiography showed severe proximal vasospasm in 1 patient, proximal and distal in 3 patients, and distal in 3 patients. There was also moderate proximal vasospasm in 4 patients, proximal and distal in 1 patient, and distal in 1 patient. Complete occlusion of the aneurysm was achieved in 5 patients, incomplete occlusion in 3 patients, and a small neck remnant in 2 patients. Final angiograms also demonstrated complete clearance of a proximal spasm in 4 patients, and complete clearance of proximal and distal spasms in another 4 patients. Mean initial dose of nimodipine was 1.375 mg, and mean continuous infusion dose was 1.275 mg (mean total dose, 2.65 mg). No medical complications related to extended infusion of nimodipine occurred.

CONCLUSION: In this small series, extended intra-arterial infusion of nimodipine up to the end of the embolization procedure was effective and safe in patients with a ruptured aneurysm and associated vasospasm. This technique seems to increase the security of the procedure as well as force further vasorelaxation when the endovascular route is used to treat both the aneurysm and vasospasm in a single step." />
<meta name="DC.Contributor" content="I. Oran" />
<meta name="DC.Contributor" content="C. Cinar" />
<meta name="article:published_time" content="2008-02-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Continuous Intra-Arterial Infusion of Nimodipine During Embolization of Cerebral Aneurysms Associated With Vasospasm" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;b&gt;BACKGROUND AND PURPOSE:&lt;/b&gt; Despite rigorous efforts, cerebral vasospasm remains an important cause of morbidity and mortality in patients who survive their initial subarachnoid hemorrhage. In cases of intracranial ruptured aneurysm associated with vasospasm, we evaluated the effectiveness of combined embolization of an aneurysm and intra-arterial infusion of nimodipine, which continued during the entire procedure.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Materials and METHODS:&lt;/b&gt; Ten patients with ruptured aneurysms associated with vasospasm who were treated in a single session were reviewed retrospectively. After initial intra-arterial infusion of nimodipine (1–2 mg within 10–15 minutes), they underwent occlusion of the aneurysm with coils under continuous intra-arterial infusion of nimodipine at a dose of 1 mg per hour.&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS:&lt;/b&gt; Angiography showed severe proximal vasospasm in 1 patient, proximal and distal in 3 patients, and distal in 3 patients. There was also moderate proximal vasospasm in 4 patients, proximal and distal in 1 patient, and distal in 1 patient. Complete occlusion of the aneurysm was achieved in 5 patients, incomplete occlusion in 3 patients, and a small neck remnant in 2 patients. Final angiograms also demonstrated complete clearance of a proximal spasm in 4 patients, and complete clearance of proximal and distal spasms in another 4 patients. Mean initial dose of nimodipine was 1.375 mg, and mean continuous infusion dose was 1.275 mg (mean total dose, 2.65 mg). No medical complications related to extended infusion of nimodipine occurred.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSION:&lt;/b&gt; In this small series, extended intra-arterial infusion of nimodipine up to the end of the embolization procedure was effective and safe in patients with a ruptured aneurysm and associated vasospasm. This technique seems to increase the security of the procedure as well as force further vasorelaxation when the endovascular route is used to treat both the aneurysm and vasospasm in a single step.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2008/02/01" />
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<meta name="citation_author" content="I. Oran" />
<meta name="citation_author" content="C. Cinar" />
<meta name="twitter:title" content="Continuous Intra-Arterial Infusion of Nimodipine During Embolization of Cerebral Aneurysms Associated With Vasospasm" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Despite rigorous efforts, cerebral vasospasm remains an important cause of morbidity and mortality in patients who survive their initial subarachnoid hemorrhage. In cases of intracranial ruptured aneurysm associated with vasospasm, we evaluated the effectiveness of combined embolization of an aneurysm and intra-arterial infusion of nimodipine, which continued during the entire procedure.

Materials and METHODS: Ten patients with ruptured aneurysms associated with vasospasm who were treated in a single session were reviewed retrospectively. After initial intra-arterial infusion of nimodipine (1–2 mg within 10–15 minutes), they underwent occlusion of the aneurysm with coils under continuous intra-arterial infusion of nimodipine at a dose of 1 mg per hour.

RESULTS: Angiography showed severe proximal vasospasm in 1 patient, proximal and distal in 3 patients, and distal in 3 patients. There was also moderate proximal vasospasm in 4 patients, proximal and distal in 1 patient, and distal in 1 patient. Complete occlusion of the aneurysm was achieved in 5 patients, incomplete occlusion in 3 patients, and a small neck remnant in 2 patients. Final angiograms also demonstrated complete clearance of a proximal spasm in 4 patients, and complete clearance of proximal and distal spasms in another 4 patients. Mean initial dose of nimodipine was 1.375 mg, and mean continuous infusion dose was 1.275 mg (mean total dose, 2.65 mg). No medical complications related to extended infusion of nimodipine occurred.

CONCLUSION: In this small series, extended intra-arterial infusion of nimodipine up to the end of the embolization procedure was effective and safe in patients with a ruptured aneurysm and associated vasospasm. This technique seems to increase the security of the procedure as well as force further vasorelaxation when the endovascular route is used to treat both the aneurysm and vasospasm in a single step." />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Despite rigorous efforts, cerebral vasospasm remains an important cause of morbidity and mortality in patients who survive their initial subarachnoid hemorrhage. In cases of intracranial ruptured aneurysm associated with vasospasm, we evaluated the effectiveness of combined embolization of an aneurysm and intra-arterial infusion of nimodipine, which continued during the entire procedure.

Materials and METHODS: Ten patients with ruptured aneurysms associated with vasospasm who were treated in a single session were reviewed retrospectively. After initial intra-arterial infusion of nimodipine (1–2 mg within 10–15 minutes), they underwent occlusion of the aneurysm with coils under continuous intra-arterial infusion of nimodipine at a dose of 1 mg per hour.

RESULTS: Angiography showed severe proximal vasospasm in 1 patient, proximal and distal in 3 patients, and distal in 3 patients. There was also moderate proximal vasospasm in 4 patients, proximal and distal in 1 patient, and distal in 1 patient. Complete occlusion of the aneurysm was achieved in 5 patients, incomplete occlusion in 3 patients, and a small neck remnant in 2 patients. Final angiograms also demonstrated complete clearance of a proximal spasm in 4 patients, and complete clearance of proximal and distal spasms in another 4 patients. Mean initial dose of nimodipine was 1.375 mg, and mean continuous infusion dose was 1.275 mg (mean total dose, 2.65 mg). No medical complications related to extended infusion of nimodipine occurred.

CONCLUSION: In this small series, extended intra-arterial infusion of nimodipine up to the end of the embolization procedure was effective and safe in patients with a ruptured aneurysm and associated vasospasm. This technique seems to increase the security of the procedure as well as force further vasorelaxation when the endovascular route is used to treat both the aneurysm and vasospasm in a single step." />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Continuous Intra-Arterial Infusion of Nimodipine During Embolization of Cerebral Aneurysms Associated With Vasospasm</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">I. Oran</span> and <span class="highwire-citation-author" data-delta="1">C. Cinar</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2008,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">29 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">291-295; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A0830 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-7859--6270474904" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">I. Oran </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=I.%2BOran%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Oran%20I&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AI.%2BOran%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">C. Cinar </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BCinar%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cinar%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.%2BCinar%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.1"><div class="cit-metadata"><cite>Jahromi BS, Macdonald RL. <strong>Vasospasm: diagnosis and medical management.</strong> In: Le Roux PD, Winn HR, Newell DW, eds. <span class="cit-source">Management of cerebral aneurysm.</span> Philadelphia: Saunders;<span class="cit-pub-date">2004</span> :<span class="cit-fpage">455</span>–87</cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.2" data-doi="10.1007/s002340050784"><div class="cit-metadata"><cite>Schuknecht B, Fandino J, Yüksel C, et al. <strong>Endovascular treatment of cerebral vasospasm: assessment of treatment effect by cerebral angiography and transcranial colour Doppler sonography.</strong> <span class="cit-source">Neuroradiology</span> <span class="cit-pub-date">1999</span>;<span class="cit-vol">41</span>:<span class="cit-fpage">453</span>–62</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s002340050784&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=10426225&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F2%2F291.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.3"><div class="cit-metadata"><cite>Biondi A, Ricciardi GK, Puybasset L, et al. <strong>Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2004</span>;<span class="cit-vol">25</span>:<span class="cit-fpage">1067</span>–76</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyNS82LzEwNjciO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjkvMi8yOTEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4 in text" id="ref-4">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.4"><div class="cit-metadata"><cite>Weir RU, Marcellus ML, Do HM, et al. <strong>Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2003</span>;<span class="cit-vol">24</span>:<span class="cit-fpage">585</span>–90</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIyNC80LzU4NSI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8yOS8yLzI5MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5 in text" id="ref-5">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.5" data-doi="10.3171/jns.2006.105.5.664"><div class="cit-metadata"><cite>Suzuki S, Jahan R, Duckwiler GR, et al. <strong>Contribution of endovascular therapy to the management of poor-grade aneurysmal subarachnoid hemorrhage: Clinical and angiographic outcomes [</strong>published erratum appears in <em>J Neurosurg</em> 2007;106:204]. <span class="cit-source">J Neurosurg</span> <span class="cit-pub-date">2006</span>;<span class="cit-vol">105</span>:<span class="cit-fpage">664</span>–70</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3171/jns.2006.105.5.664&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=17121125&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F2%2F291.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6 in text" id="ref-6">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.6" data-doi="10.1007/s002340000479"><div class="cit-metadata"><cite>Wanke I, Dörfler A, Dietrich U, et al. <strong>Combined endovascular therapy of ruptured aneurysms and cerebral vasospasm.</strong> <span class="cit-source">Neuroradiology</span> <span class="cit-pub-date">2000</span>;<span class="cit-vol">42</span>:<span class="cit-fpage">926</span>–29</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s002340000479&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=11198215&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F2%2F291.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000166068600015&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7 in text" id="ref-7">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.7"><div class="cit-metadata"><cite>Murayama Y, Song JK, Uda K, et al. <strong>Combined endovascular treatment for both intracranial aneurysm and symptomatic vasospasm.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2003</span>;<span class="cit-vol">24</span>:<span class="cit-fpage">133</span>–39</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIyNC8xLzEzMyI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8yOS8yLzI5MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8 in text" id="ref-8">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.8"><div class="cit-metadata"><cite>Firat MM, Gelebek V, Orer HS, et al. <strong>Selective intraarterial nimodipine treatment in an experimental subarachnoid hemorrhage model.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2005</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">1357</span>–62</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyNi82LzEzNTciO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjkvMi8yOTEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9 in text" id="ref-9">↵</a><div class="cit ref-cit ref-other" id="cit-29.2.291.9" data-doi="10.1016/j.crad.2005.04.004"><div class="cit-metadata"><cite>Hui C, Lau KP. <strong>Efficacy of intra-arterial nimodipine in the treatment of cerebral vasospasm complicating subarachnoid hemorrhage.</strong> <span class="cit-source">Clin Radiol</span> <span class="cit-pub-date">2005</span>;<span class="cit-vol">60</span>:<span class="cit-fpage">1030</span>–36</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.crad.2005.04.004&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16124986&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F2%2F291.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000231777100012&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li></ol></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 29</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 2 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">February 2008 </div></div>
      
      
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