, Volume 53, Issue 2, pp 123–128 | Cite as

Angiographic evaluation of the effect of intra-arterial milrinone therapy in patients with vasospasm from aneurysmal subarachnoid hemorrhage

  • Jai Jai Shiva Shankar
  • Marlise P. dos SantosEmail author
  • Leonardo Deus-Silva
  • Cheemun Lum
Interventional Neuroradiology



Several methods have been used to treat cerebral vasospasm, which is a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). Here, we examined the effectiveness and safety of intra-arterial injection of milrinone for the treatment of vasospasm.


Consecutive patients with angiographically confirmed vasospasm received intra-arterial milrinone between January 2006 and December 2007. The improvement in diameter of vessel (in millimeters) following treatment was assessed by paired t test for statistical significance. The angiographic improvement of supraclinoid internal carotid artery, M1 segment of middle cerebral artery, and A1 and A2 segment of anterior cerebral artery was compared with the modified Rankin score of the patients at discharge.


A total of 15 milrinone treatments were performed in 14 patients (11 females and 3 males) with mean age of 52.7 years (31–68 years). There was significant angiographic improvement after milrinone therapy (p < 0.0001).


Intra-arterial milrinone was a safe and effective treatment of cerebral vasospasm following aneurysmal SAH.


Milrinone Aneurysmal subarachnoid hemorrhage Vasospasm Angioplasty 



We thank Betty Anne Shwartz, our research nurse, and Dr. Faisal Al-Azri, for their contribution in collecting clinical data.

Conflict of interest statement

We declare that we have no conflict of interest.


  1. 1.
    Suarez JI, Tarr RW, Selman WR (2006) Aneurysmal subarachnoid haemorrhage. N Eng J Med 354:387–396CrossRefGoogle Scholar
  2. 2.
    Kassel NF (1993) The role of vasospasm in overall outcome from aneurismal subarachnoid haemorrhage. In: Findlay JM (ed) Cerebral vasospasm. Elsevier, Amsterdam, pp 27–28Google Scholar
  3. 3.
    Macdonald RL, Weir B (1997) Cerebral vasospasm: prevention and treatment. In: Batjer HH, Caplan LR, Friberg L et al (eds) Cerebrovascular disease. Lippincott-Raven, Philadelphia, pp 1111–1121Google Scholar
  4. 4.
    Kassell NF, Sasaki T, Colohan AR et al (1985) Cerebral vasospasm following aneurismal subarachnoid hemorrhage. Stroke 16(4):562–572PubMedGoogle Scholar
  5. 5.
    Kodama N, Mizoi K, Sakurai Y et al (1980) Incidence and onset of vasospasm. In: Wilkins RH (ed) Cerebral arterial spasm. Williams & Wilkins, Philadelphia, pp 361–365Google Scholar
  6. 6.
    Awad IA, Carter P, Spetzler RE et al (1987) Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 18:365–372PubMedGoogle Scholar
  7. 7.
    Arakawa Y, Kikuta K, Hojo M et al (2001) Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases. Neurosurgery 48:723–730CrossRefPubMedGoogle Scholar
  8. 8.
    Arakawa Y, Kikuta K, Hojo M et al (2004) Milrinone reduces cerebral vasospasm after subarachnoid hemorrhage of WFNS grade IV or V. Neurol Med Chir (Tokyo) 44:393–401CrossRefGoogle Scholar
  9. 9.
    Birk S, Edvinsson L, Olesen J et al (2004) Analysis of the effects of phosphodiesterase type 3 and 4 inhibitors in cerebral arteries. Eur J Pharmacol 489:93–100CrossRefPubMedGoogle Scholar
  10. 10.
    Lavine S, Wang M, Etu J et al (2007) Augmentation of cerebral blood flow and reversal of endothelin-1-induced vasospasm: a comparison of intra-carotid nicardipine and verapamil. Neurosurgery 60(4):742–749CrossRefPubMedGoogle Scholar
  11. 11.
    Kaku Y, Yonekawa Y, Tsukahara T et al (1992) Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77:842–847CrossRefPubMedGoogle Scholar
  12. 12.
    Biondi A, Ricciardi GK, Puybasset L et al (2004) Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. Am J Neuroradiol 25:1067–1076PubMedGoogle Scholar
  13. 13.
    Badjatia N, Topcuoglu MA, Pryor JC et al (2004) Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm. Am J Neuroradiol 25:819–826PubMedGoogle Scholar
  14. 14.
    Elliott JP, Newell DW, Lam DJ et al (1998) Comparison of balloon angioplasty and papavarin infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 88:277–284CrossRefPubMedGoogle Scholar
  15. 15.
    Delgado AL, Jahromi B, Müller N et al (2008) Endovascular therapy of cerebral vasospasm: two year experience with angioplasty and/or intra-arterial administration of nicardipine and verapamil. Acta Neurochir Suppl 104:347–351CrossRefGoogle Scholar
  16. 16.
    Shibuya M, Suzuki Y, Sugita K et al (1992) Effects of AT877 in cerebral vasospasm after aneurismal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. J Neurosurg 76:571–577CrossRefPubMedGoogle Scholar
  17. 17.
    Yoneyama M, Sugiyama A, Satoh Y et al (2002) Cardiovascular and adenylate cyclase stimulating effects of colforsin daropate, a water soluble forskolin derivative, compared with those of isoproterenol, dopamine and dobutamine. Circ J 66:1150–1154CrossRefPubMedGoogle Scholar
  18. 18.
    Suzuki S, Ito O, Sayama T, Goto K (2010) Satoshi S, Osamu I, Tetsuro S, Katsuya G. Intra-arterial colforsin daropate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Neuroradiology. doi: 10.1007/s00234-009-0631-7
  19. 19.
    Terry A, Zipfel G, Milner E et al (2006) Safety and technical efficacy of over the wire balloons for the treatment of subarachnoid hemorrhage induced cerebral vasospasm. Neurosurg Focus 21(3):E14, 1–7CrossRefPubMedGoogle Scholar
  20. 20.
    Elsayed AA, Moran CJ, Cross DT et al (2006) Effect of intraarterial papavarine and/or angioplasty on the cerebral veins in patients with vasospasm after subarachnoid hemorrhage due to ruptured intracranial aneurysms. Neurosurg Focus 21(3):E16, 1–9CrossRefPubMedGoogle Scholar
  21. 21.
    Khajavi K, Ayzman I, Shearer D et al (1997) Prevention of chronic cerebral vasospasm in dogs with milrinone. Neurosurgery 40:354–363CrossRefPubMedGoogle Scholar
  22. 22.
    Fraticelli AT, Cholley BP, Losser M et al (2008) Milrinone for the treatment of cerebral vasospasm after aneurismal subarachnoid hemorrhage. Stroke 39:893–898CrossRefPubMedGoogle Scholar
  23. 23.
    Mindea SA, Yang BP, Bendok BR et al (2006) Endovascular treatment strategies for cerebral vasospasm. Neurosurg Focus 21(3):E13, 1–7CrossRefPubMedGoogle Scholar
  24. 24.
    Shankar JJS, Chakraborty S, Nugyen TB, Dos Santos M, Miller W, Lum C (2009) Whole brain CT perfusion on new 320 slice CT scanner: pictorial review—Electronic exhibit—in American Society of Neuroradiology (ASNR) Conference—Vancouver, 16–21 May, 2009Google Scholar
  25. 25.
    Dankbaar JW, Rijsdijk M, van der Schaaf IC, Velthuis BK, Wermer MJ, Rinkel GJ (2009) Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Neuroradiology 51(12):813–819CrossRefPubMedGoogle Scholar
  26. 26.
    Aralasmak A, Akyuz M, Ozkaynak C, Sindel T, Tuncer R (2009) CT angiography and perfusion imaging in patients with subarachnoid hemorrhage: correlation of vasospasm to perfusion abnormality. Neuroradiology 51(2):85–93CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Jai Jai Shiva Shankar
    • 1
  • Marlise P. dos Santos
    • 2
    Email author
  • Leonardo Deus-Silva
    • 2
  • Cheemun Lum
    • 2
  1. 1.Department of Medical ImagingThe Ottawa HospitalOttawaCanada
  2. 2.Department of Diagnostic ImagingThe Ottawa HospitalOttawaCanada

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