Milrinone Via Lumbar Subarachnoid Catheter for Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2014 Jun 6

PMID 24899113

Citations 4

Authors

Nobutake Sadamasa

Kazumichi Yoshida

Osamu Narumi

Masaki Chin

Sen Yamagata

Affiliations

Soon will be listed here.

Abstract

Introduction: Delayed ischemic neurological deficit (DIND) due to symptomatic vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to elucidate the safety and feasibility of intrathecal milrinone infusion via lumber subarachnoid catheter for prevention of DIND after aSAH.

Methods: We diagnosed 425 consecutive patients with aSAH who received clipping or coil embolization within 48 h after arrival. Patients with the evidence of vasospasm on CT angiography (CTA) received the milrinone therapy via lumbar subarachnoid catheter. DIND, delayed cerebral infarction (DCI), and modified Rankin scale at 3 months after SAH were used for the assessment of outcome.

Results: Of 425 patients, 170 patients (40.0 %) with CTA-proven vasospasm received the milrinone therapy. DIND was observed in 68 patients (16.0 %), DCI in 30 patients (7.1 %), and the overall mortality was 7.2 %. In patients with WFNS grade IV and V aSAH, 26 out of 145 patients (17.9 %) were presented with DIND, 12 (8.3 %) with DCI, and the mortality was 16.0 %. No major complication related to the milrinone injection was observed.

Conclusion: Intrathecal milrinone injection via lumbar catheter was safe and feasible, and further randomized prospective studies are needed to confirm the effectiveness of this regimen in the patients with SAH.

Citing Articles

Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review.

Santos-Teles A, Ramalho C, Ramos J, da Hora Passos R, Gobatto A, Farias S Rev Bras Ter Intensiva. 2021; 32(4):592-602.

PMID: 33470361 PMC: 7853682. DOI: 10.5935/0103-507X.20200097.

Protective effect of unilateral vasospasm in the setting of HHH-associated posterior reversible encephalopathy syndrome: case report, review of the literature, and treatment considerations.

Raghavan A, Xu J, Wright J, Wright C, Miller B, Hu Y Chin Neurosurg J. 2020; 4:34.

PMID: 32922894 PMC: 7398370. DOI: 10.1186/s41016-018-0141-8.

Basilar artery vasospasm after pretuncal non-aneurysmal subarachnoid hemorrhage responding to milrinone.

Alturki A, Alamri A, Badawy M, Lo B Neurosciences (Riyadh). 2017; 22(2):134-137.

PMID: 28416786 PMC: 5726820. DOI: 10.17712/nsj.2017.2.20160451.

Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis.

Boulouis G, Labeyrie M, Raymond J, Rodriguez-Regent C, Lukaszewicz A, Bresson D Eur Radiol. 2016; 27(8):3333-3342.

PMID: 28004163 DOI: 10.1007/s00330-016-4702-y.

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