AUTHOR=Kapapa Thomas , König Ralph , Mayer Benjamin , Braun Michael , Schmitz Bernd , Müller Silwia , Schick Julia , Wirtz Christian Rainer , Pala Andrej 

TITLE=Adverse Events and Complications in Continuous Intra-arterial Nimodipine Infusion Therapy After Aneurysmal Subarachnoid Hemorrhage

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.812898

DOI=10.3389/fneur.2021.812898

ISSN=1664-2295

ABSTRACT=Objective
To determine the frequencies and severity of complications associated with continuous intra-arterial infusion of nimodipine (CIANI) as a new treatment of Delayed Cerebral Ischemia (DCI) after aneurysmatic Subarachnoid Hemorrhage (SAH), we retrospectively evaluated data of 718 patients from two centers.
Methods
Patients treated on SAH between 2008 and 2016 were included. Frequencies of adverse events (AE), complications, their detailed characterization and severity (mild, moderate and severe) were evaluated, relative risk methods were used with the level of significance at p≤0.05. Clinical outcome was analyzed using Glasgow Outcome Scale (GOS). Unfavorable outcome was defined as GOS 1 to 3, favorable outcome as GOS 4 to 5. The Short-Form 36 (SF-36) health-related quality of life questionnaire severed as quality of life measurement.
Results
Out of 718 patients, 65 (9%) were treated by CIANI and had a higher clinical or imaging grad of bleeding severity. Clinical deterioration during the treatment course happened more often in patients treated with CIANI than in others. 67% of patients treated by CIANI had adverse events and/or complications during the treatment. Nimodipine-associated hypotension was seen in 8% (mild). Catheter associated thrombus occurred in 9% (moderate). New intracerebral hemorrhage was found in 14% (moderate). 6% treated by CIANI died during the treatment period (severe). More than one third (38.5%) of patients in CIANI cohort reached at least moderate disability and 23.1% showed good recovery. Patients after CIANI have reduced quality of life (QoL) based on SF-36 questionnaire, but differences in mental and general health, and pain were minimal. The relative risk for unfavorable outcome in those patients is 1,3 (CI 0.97 – 1.62, p=0.049) compared to other patients with SAH.

Conclusion
CIANI is related to higher rates of adverse events and complications compared to standard treatment of SAH. However, in those selected cases of CIANI patients with severe and therapy-refractory DCI CIANI is beneficial for outcome.