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Nimodipine vs. Milrinone - Equal or Complementary Use? A Retrospective Analysis.

Jennifer Jentzsch1, Svitlana Ziganshyna2, Dirk Lindner3

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Frontiers in Neurology
|August 1, 2022
PubMed
Summary

Intra-arterial nimodipine is more effective than milrinone for treating cerebral vasospasm after subarachnoid hemorrhage. Nimodipine, alone or combined with milrinone, prevents infarction, unlike milrinone monotherapy.

Keywords:
cerebral vasospasmdelayed cerebral ischemiaendovascular proceduresmilrinonenimodipinesubarachnoid hemorrhage

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Area of Science:

  • Neurology
  • Vascular Surgery
  • Pharmacology

Background:

  • Cerebral vasospasm (CVS) significantly increases morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH) survivors.
  • Nimodipine is the sole approved drug for reducing delayed cerebral ischemia (DCI) but is not thought to impact large vessel CVS.
  • Milrinone presents a potential alternative for managing CVS.

Purpose of the Study:

  • To evaluate the efficacy of intra-arterial nimodipine and milrinone, as monotherapy and in combination, for treating CVS.
  • To compare the vasodilating effects and clinical outcomes associated with these treatments.

Main Methods:

  • Retrospective analysis of 30 patients with aneurysmal SAH and angiographically confirmed CVS undergoing intra-arterial pharmacological angioplasty.
  • Assessment of vessel diameter changes in 10 defined segments before and after vasodilator infusion.
  • Comparison of vasodilation, DCI-related cerebral infarction, and modified Rankin Scale (mRS) scores.

Main Results:

  • Intra-arterial nimodipine demonstrated superior vasodilating effects compared to milrinone in intradural segments.
  • Nimodipine monotherapy or combined therapy prevented DCI-related infarction (57.1%), whereas milrinone monotherapy did not (87.5%).
  • Both agents increased vasopressor demand; milrinone monotherapy also induced tachycardia. No significant difference in mRS scores was observed.

Conclusions:

  • Intra-arterial nimodipine monotherapy is more effective than milrinone for CVS treatment.
  • A complementary approach using nimodipine first, followed by milrinone for severe CVS, is recommended.
  • Milrinone monotherapy is not advised due to its limited efficacy in preventing DCI-related infarction.