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Published on: March 15, 2022

Continuous Intra-arterial Nimodipine Therapy in SAH Patients With Refractory DCI-Factors Associated With Insufficient

Elena Kurz1, Darius Kalasauskas1, Florian Ringel1

  • 1Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

World Neurosurgery
|July 30, 2026
PubMed

Insights

Continuous intra-arterial nimodipine infusion (CIAN) is a feasible rescue therapy for delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, recurrence was common, and insufficient response correlated with severe disease markers and poor outcomes.

Area of Science:

  • Neuroendovascular therapy
  • Cerebrovascular diseases
  • Neurosurgery

Background:

  • Continuous intra-arterial nimodipine infusion (CIAN) serves as an endovascular rescue therapy for refractory delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH).
  • The efficacy, response rates, and recurrence patterns of CIAN remain incompletely understood.

Purpose of the Study:

  • To evaluate the effectiveness and outcomes of CIAN in patients with refractory DCI after aSAH.
  • To characterize treatment response, vasospasm recurrence, and associated clinical factors.

Main Methods:

  • A retrospective analysis of 36 aSAH patients treated with CIAN between 2016 and 2023.
  • Patients had imaging-confirmed vasospasm and perfusion deficits refractory to standard treatments.
  • Key outcomes included treatment response, recurrence, DCI-related infarctions, and 6-month functional outcome (mRS).

Main Results:

  • 44% of patients achieved a sufficient response (>75% vessel caliber restoration with perfusion improvement).
  • Recurrence occurred in 39% of patients, with 19% requiring repeat CIAN.
  • Insufficient response was linked to higher WFNS/mFS scores, multiple aneurysms, generalized vasospasm, and unfavorable outcomes.

Conclusions:

  • CIAN is a feasible endovascular rescue strategy for selected aSAH patients with refractory DCI.
  • Vasospasm recurrence is common, and insufficient response is associated with severe disease indicators.
  • Further prospective studies are warranted to optimize CIAN protocols and patient selection.
Abstract

Keywords:
Cerebral vasospasmDelayed cerebral ischemiaEndovascularIntraarterial nimodipine therapySAHSalvage therapy

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