Konstantin Hockel1, Jennifer Diedler2, Jochen Steiner2, Ulrich Birkenhauer2, Ulrike Ernemann3, Martin U Schuhmann2. 1. Department of Neurosurgery, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany. Electronic address: konstantin.hockel@med.uni-tuebingen.de. 2. Department of Neurosurgery, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany. 3. Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany.
Abstract
BACKGROUND: For the treatment and prevention of delayed cerebral ischemia after subarachnoid hemorrhage, the vasodilating agent nimodipine (NDP) is widely employed. This study investigates the effect of NDP on cerebrovascular autoregulation, assessed by pressure reactivity index (PRx), and brain tissue oxygenation (pbrO2) when given continuously intravenously as an intra-arterial bolus or during continuous intra-arterial therapy. METHODS: Computerized continuous neuromonitoring data (intracranial pressure, mean arterial pressure, cerebral perfusion pressure [CPP], pbrO2, PRx) of 105 patients with aneurysmal SAH were retrospectively evaluated. The effect of NDP on all parameters was compared when applied intra-arterially for the treatment of severe macrovasospasm leading to perfusion deficits as either bolus treatment (n = 111 in 37 patients) or continuous infusion (n = 20 patients) to patients without or with only mild macrovasospasm who received either intravenous NDP or no NDP at all. RESULTS: Compared with patients without treatment, the intravenous application of NDP was associated with a significantly higher PRx. Autoregulation was strongly and long lastingly affected (high PRx) in continuous intra-arterial NDP infusion, accompanied by a sustained improvement of pbrO2. Intra-arterial bolus NDP application resulted as well in a significant increase of pbrO2 and PRx; the induced effect, however, was transient and subsided within 6 hours. Intracranial pressure, mean arterial pressure, and CPP were not affected during the monitoring period. CONCLUSION: The pharmacologically induced alteration of the cerebrovascular autoregulation by NDP correlates with changes of pbrO2 and indicates a beneficial effect on cerebral blood flow if CPP is maintained. This effect is limited to a few hours after bolus treatment and milder for intravenous compared with intra-arterial application.
BACKGROUND: For the treatment and prevention of delayed cerebral ischemia after subarachnoid hemorrhage, the vasodilating agent nimodipine (NDP) is widely employed. This study investigates the effect of NDP on cerebrovascular autoregulation, assessed by pressure reactivity index (PRx), and brain tissue oxygenation (pbrO2) when given continuously intravenously as an intra-arterial bolus or during continuous intra-arterial therapy. METHODS: Computerized continuous neuromonitoring data (intracranial pressure, mean arterial pressure, cerebral perfusion pressure [CPP], pbrO2, PRx) of 105 patients with aneurysmalSAH were retrospectively evaluated. The effect of NDP on all parameters was compared when applied intra-arterially for the treatment of severe macrovasospasm leading to perfusion deficits as either bolus treatment (n = 111 in 37 patients) or continuous infusion (n = 20 patients) to patients without or with only mild macrovasospasm who received either intravenous NDP or no NDP at all. RESULTS: Compared with patients without treatment, the intravenous application of NDP was associated with a significantly higher PRx. Autoregulation was strongly and long lastingly affected (high PRx) in continuous intra-arterial NDP infusion, accompanied by a sustained improvement of pbrO2. Intra-arterial bolus NDP application resulted as well in a significant increase of pbrO2 and PRx; the induced effect, however, was transient and subsided within 6 hours. Intracranial pressure, mean arterial pressure, and CPP were not affected during the monitoring period. CONCLUSION: The pharmacologically induced alteration of the cerebrovascular autoregulation by NDP correlates with changes of pbrO2 and indicates a beneficial effect on cerebral blood flow if CPP is maintained. This effect is limited to a few hours after bolus treatment and milder for intravenous compared with intra-arterial application.
Authors: Miriam Weiss; Walid Albanna; Catharina Conzen-Dilger; Nick Kastenholz; Katharina Seyfried; Hani Ridwan; Martin Wiesmann; Michael Veldeman; Tobias Philip Schmidt; Murad Megjhani; Henna Schulze-Steinen; Hans Clusmann; Marinus Johannes Hermanus Aries; Soojin Park; Gerrit Alexander Schubert Journal: Stroke Date: 2022-06-08 Impact factor: 10.170
Authors: Thomas Kapapa; Ralph König; Benjamin Mayer; Michael Braun; Bernd Schmitz; Silwia Müller; Julia Schick; Christian Rainer Wirtz; Andrej Pala Journal: Front Neurol Date: 2022-02-18 Impact factor: 4.003
Authors: Andreas Kramer; Moritz Selbach; Thomas Kerz; Axel Neulen; Marc A Brockmann; Florian Ringel; Carolin Brockmann Journal: Front Neurol Date: 2022-03-15 Impact factor: 4.003
Authors: Johannes Walter; Martin Grutza; Markus Möhlenbruch; Dominik Vollherbst; Lidia Vogt; Andreas Unterberg; Klaus Zweckberger Journal: J Clin Med Date: 2022-04-05 Impact factor: 4.241