ArticleNeurocritical care2024
Stellate Ganglion Block and Intraarterial Spasmolysis in Patients with Cerebral Vasospasm: A Retrospective Cohort Study.
Article in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 5 citations in OpenAlex.
- Efficacy and safety of milrinone infusion in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.Frontiers in neurology · 2026Pooled it
- Associations Between Delayed Cerebral Ischemia in Spontaneous Subarachnoid Hemorrhage and Dysfunction of Autonomic Cardiovascular Modulation Compared to Transcranial Doppler Ultrasound Findings.Diagnostics (Basel, Switzerland) · 2026Article
- Anatomy, Imaging, and Clinical Significance of the Cervicothoracic (Stellate) Ganglion.Diagnostics (Basel, Switzerland) · 2025Review
- The Ganglia of the Head and Neck: Clinical Relevance for the Interventional Pain Physician.Current pain and headache reports · 2025Review
- Repetitive intraarterial therapy with Milrinone and Nimodipine for severe refractory Vasospasm: own series and narrative literature review.Brain & spine · 2025Article
- The potential role of stellate ganglion block in impacting the central and peripheral systems: a narrative review.Frontiers in cardiovascular medicine · 2025Review
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn patients with symptomatic cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage who do not respond to medical therapy, urgent treatment escalation has been suggested to be beneficial for brain tissue at risk. In our routine clinical care setting, we implemented stellate ganglion block (SGB) as a rescue therapy with subsequent escalation to intraarterial spasmolysis (IAS) with milrinone for refractory CV.
methodsIn this retrospective analysis from 2012 to 2021, patients with CV following aneurysmal subarachnoid hemorrhage who received an SGB or IAS were identified. Patients were assessed through neurological examination and transcranial Doppler. Rescue therapy was performed in patients with mean cerebral blood flow velocity (CBFV) ≥ 120 cm/s and persistent neurological deterioration/intubation under induced hypertension. Patients were reassessed after therapy and the following day. The Glasgow Outcome Scale was assessed at discharge and 6-month follow-up.
resultsA total of 82 patients (mean age 50.16 years) with 184 areas treated with SGB and/or IAS met the inclusion criteria; 109 nonaffected areas were extracted as controls. The mean CBFV decrease in the middle cerebral artery on the following day was - 30.1 (± 45.2) cm/s with SGB and - 31.5 (± 45.2) cm/s with IAS. Mixed linear regression proved the significance of the treatment categories; other fixed effects (sex, age, aneurysm treatment modality [clipping or coiling], World Federation of Neurological Surgeons score, and Fisher score) were insignificant. In logistic regression, the presence of cerebral infarction on imaging before discharge from the intensive care unit (34/82) was significantly associated with unfavorable outcomes (Glasgow Outcome Scale ≤ 3) at follow-up.
conclusionsStellate ganglion block and IAS decreased CBFV the following 24 h in patients with CV. We suggest SGB alone for patients with mild symptomatic CV (CBFV < 180 cm/s), while subsequent escalation to IAS proved to be beneficial in patients with refractory CV and severe CBFV elevation (CBFV ≥ 180 cm/s).
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