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Clinical outcomes in spontaneous subarachnoid hemorrhage after introduction of continuous intra-arterial vasospasmolysis for treatment of refractory delayed cerebral ischemia

Year: 2025

Type: article

Abstract: Background: In patients with refractory delayed cerebral ischemia (DCI) after spontaneous subarachnoid hemorrhage (SAH), endovascular therapy of cerebral vasospasms is a treatment option. In our center, continuous intra-arterial vasospasmolysis with nimodipine (ciaN) has been introduced as the standard endovascular therapy for cerebral vasospasms since 2016. This study investigated the outcomes of SAH patients before and after introduction of ciaN. Methods: Data pertaining to all patients treated for SAH in our center between 2011 and 2021 were retrospectively recorded. Results: 145 patients before (pre-ciaN group) and 147 after (ciaN group) introduction of ciaN met the inclusion criteria. 36 patients in the pre-ciaN group and 51 in the ciaN group received endovascular vasospasm treatment. At discharge, outcomes tended to improve in the ciaN group. After 6 months, there was a significantly improved outcome in the ciaN group (mRS 0-2, Fisher's exact test). After propensity score matching, there were no significant differences between the pre-ciaN and ciaN groups in the subgroups of patients without endovascular vasospasm treatments. Conversely, in the subgroups of patients who had received endovascular vasospasm treatments, there was a significantly improved outcome at discharge and after 6 months, and a significant reduction of DCI-associated infarctions. Conclusion: Outcome after spontaneous subarachnoid hemorrhage has improved since the introduction of ciaN in our center. Our data indicate a contribution of the changes in treatment standard for endovascular vasospasm therapies from angioplasties to ciaN. Prospective studies are needed to compare the effect of ciaN in DCI with standard medical therapy.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2025.1636083