Title : Intra-arterial nimodipine and outcomes in delayed cerebral ischemia after aneurysmal subarachnoid haemorrhage
Abstract:
Objective: Delayed cerebral ischemia (DCI) caused by cerebral vasospasm remains a major cause of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Intra-arterial nimodipine (IAN) is increasingly used as rescue therapy in patients with vasospasm refractory to induced hypertension, although data regarding outcomes and repeated infusions remain limited. This study evaluated functional outcomes and mortality in patients treated with IAN after aSAH.
Methods: We retrospectively identified all patients with DCI after aSAH treated with IAN in a tertiary center between 2017 and 2024. Clinical and radiological data, treatment characteristics, and outcomes were analyzed. Primary endpoints were six-month mortality and unfavorable functional outcome defined as modified Rankin Scale (mRS) score >2 at 3 6 months. Logistic regression analyses were used to identify factors associated with mortality and unfavorable outcomes.
Results: Fifty-two patients were included with a mean age of 53 years; 65.4% were female. At 3–6 months, 46.2% of patients achieved functional independence, while 53.8% had unfavorable outcomes. Six-month mortality was 10.0%. Higher Hunt and Hess grade, Glasgow Coma Scale score of 3–8 on admission, intraventricular hemorrhage, and repeated IAN administration were associated with unfavorable functional outcome. Older age and pre-existing anticoagulant and/or antiplatelet therapy were associated with increased mortality. Post-treatment infarcts were identified in 26.9% of patients, while infarcts developing despite IAN treatment occurred in 15.4%. Repeated IAN administration did not significantly increase six-month mortality but was associated with poorer functional outcomes and a higher likelihood of permanent cerebrospinal fluid shunt placement.
Conclusions: Despite representing a subgroup of severely affected aSAH patients with symptomatic vasospasm, nearly half of the patients treated with IAN achieved functional independence after 3–6 months. Mortality rates were lower than those reported in several population-based aSAH cohorts. Repeated IAN administration was associated with less favorable functional outcomes, likely reflecting greater disease severity.
