ArticleBrain & spine2025
Repetitive intraarterial therapy with Milrinone and Nimodipine for severe refractory Vasospasm: own series and narrative literature review.
Article in Brain & spine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Dangers of orbital retraction in transorbital neuroendoscopic surgery.Acta neurochirurgica · 2026Review
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Authors and funding
6 authors.
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Abstract
Introduction: Cerebral vasospasm (VSP) following aneurysmal subarachnoid hemorrhage remains a major source of morbidity. The best rescue treatment option remains uncertain. Intraarterial (ia) Milrinone and Nimodipine were suggested as safe treatment options. Research question: We aimed to evaluate the effect of repetitive endovascular intraarterial (ia) combined Milrinone and Nimodipine administration as rescue therapy for severe refractory cerebral VSP. Material & methods: In this retrospective single center series, we included only patients with refractory VSP despite maximum standard conservative therapy. Inclusion criteria for endovascular rescue treatment were elevated transcranial Doppler (TCD) > 180 cm/s and/or significant clinical neurological deterioration. Patients received ia therapy with Nimodipine 2 mg followed by Milrinone 5 mg. Repetitive reinterventions were indicated in cases of refractory VSP. We evaluated pre- and direct posttreatment neurological status, mRS at final clinical follow-up, TCD values and measured the DSA pre-postinterventional vessel diameters. Results: 38 aSAH patients received ia therapy. Of those, 18 patients (47.4 %) received ≥3 interventions (average:3.4 ± 2.6; maximum:11). Immediate improvement of neurological deficits was seen in 31/38 patients (81.6 %). Overall mortality was low (3/38, 7.9 %). The clinical follow-up after 4 months showed persistent improvement in 24/38 patients (63.2 %) with good clinical outcomes (mRS ≤3). Immediate postinterventional angiographic improvement of vessel diameter was shown in 97,7 % (127/130) of all interventions. Neither severe cardiovascular nor reintervention-related adverse events were observed. Discussion and conclusion: In this series repetitive ia interventions combining Milrinone and Nimodipine showed promising clinical results and low mortality for refractory VSP. Larger prospective randomized clinical trials are warranted. Trial registration: ISRCTN, study ID ISRCTN36126862 registered 21.11.2018, retrospectively registered, http://www.isrctn.com/ISRCTN36126862.
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