Iatrogenic arterial vasospasm during mechanical thrombectomy requiring treatment with intra‐arterial nimodipine might be associated with worse outcomes
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND PURPOSE: Vasospasm is a common iatrogenic event during mechanical thrombectomy (MT). In such circumstances, intra-arterial nimodipine administration is occasionally considered. However, its use in the treatment of iatrogenic vasospasm during MT has been poorly studied. We investigated the impact of iatrogenic vasospasm treated with intra-arterial nimodipine on outcomes after MT for large vessel occlusion stroke. METHODS: We conducted a retrospective analysis of the multicenter observational registry Endovascular Treatment in Ischemic Stroke (ETIS). Consecutive patients treated with MT between January 2015 and December 2022 were included. Patients treated with medical treatment alone, without MT, were excluded. We also excluded patients who received another in situ vasodilator molecule during the procedure. Outcomes were compared according to the occurrence of cervical and/or intracranial arterial vasospasm requiring intraoperative use of in situ nimodipine based on operator's decision, using a propensity score approach. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Secondary outcomes included excellent outcome (mRS score 0-1), final recanalization, mortality, intracranial hemorrhage and procedural complications. Secondary analyses were performed according to the vasospasm location (intracranial or cervical). RESULTS: Among 13,678 patients in the registry during the study period, 434 received intra-arterial nimodipine for the treatment of MT-related vasospasm. In the main analysis, comparable odds of favorable outcome were observed, whereas excellent outcome was significantly less frequent in the group with vasospasm requiring nimodipine (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.63-0.97). Perfect recanalization, defined as a final modified Thrombolysis In Cerebral Infarction score of 3 (aOR 0.63, 95% CI 0.42-0.93), was also rarer in the vasospasm group. Intracranial vasospasm treated with nimodipine was significantly associated with worse clinical outcome (aOR 0.64, 95% CI 0.45-0.92), in contrast to the cervical location (aOR 1.37, 95% CI 0.54-3.08). CONCLUSION: Arterial vasospasm occurring during the MT procedure and requiring intra-arterial nimodipine administration was associated with worse outcomes, especially in case of intracranial vasospasm. Although this study cannot formally differentiate whether the negative consequences were due to the vasospasm itself, or nimodipine administration or both, there might be an important signal toward a substantial clinical impact of iatrogenic vasospasm during MT.
Source: European Journal of Neurology
DOI: 10.1111/ene.16467
Authors: Serine Ferhat, Guillaume Bellanger, Malgorzata Milnerowicz, Maeva Kyheng, Julien Labreuche, Igor Sibon, Mehdi Khobzi, Joe‐Marie Abousleiman, Dan‐Adrian Popica, Solene Moulin, Cyril Dargazanli, Arturo Consoli, Omer Eker, Louis Veunac, Kevin Premat, Benjamin Gory, Jean‐Christophe Gentric, Ricardo Moreno, Wagih Ben Hassen, Maxime Gauberti, Raoul Pop, Aymeric Rouchaud, Romain Bourcier, Bertrand Lapergue, Gaultier Marnat, ETIS investigators
Institutions: Centre Hospitalier Universitaire de Bordeaux, Centre Hospitalier Universitaire de Toulouse, Centre Hospitalier Universitaire de Lille, Fondation de Rothschild, Spitalul Clinic Judeţean de Urgenţă "Pius Brînzeu" Timişoara, Assistance Publique – Hôpitaux de Paris, Bicêtre Hospital, Centre Hospitalier Universitaire de Reims, Centre Hospitalier Universitaire de Montpellier, Hôpital Foch, Hospices Civils de Lyon, Centre Hospitalier de la Côte Basque, Pitié-Salpêtrière Hospital, Centre Hospitalier Régional et Universitaire de Nancy, Centre Hospitalier Régional Universitaire de Brest, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre Hospitalier Sainte-Anne, Centre Hospitalier Universitaire de Caen Normandie, Hôpitaux Universitaires de Strasbourg, Centre Hospitalier Universitaire de Limoges, Centre Hospitalier Universitaire de Nantes
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,600
Funder: National Institutes of Health
OpenAlex ID: W4402375909