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Milrinone as a Rescue Therapy for Symptomatic Refractory Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

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Abstract

Introduction

Delayed ischemic neurological deficit associated to cerebral vasospasm is the most common cause of sequelae and death that follows the rupture of an aneurysm. The objective of this study was to evaluate the safety and efficacy of intra-arterial Milrinone in patients with symptomatic refractory cerebral vasospasm.

Patients and Method

Eight patients diagnosed with aneurysmal subarachnoid hemorrhage who developed symptomatic cerebral vasospasm refractory to conventional medical therapy were enrolled. They received an intra-arterial infusion of Milrinone at a rate of 0.25 mg/min, with a total dose of 10–15 mg. Qualitative evaluation of angiographic response, neurological and systemic complications as well as functional outcome at 3 months were documented.

Results

All patients had a significant angiographic response. This was evidenced by a pre-treatment vessel stenosis greater than 70%, that improved to less than 50% after the intra-arterial Milrinone infusion. Three patients developed recurrent vasospasm that improved after a second intra-arterial Milrinone infusion. None of the patients developed neurologic or systemic complications attributed to the intervention. At 3 months follow-up all patients were alive and had a mean modified Rankin scale of 2 ± 1 and a Barthel index of 83 ± 10.

Conclusion

Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

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Authors and Affiliations

  1. Critical Patient Unit, Department of Medicine, Clinical Hospital, University of Chile, Santiago Norte, Chile

    C. M. Romero, D. Morales & J. Castro

  2. Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Facultad de Medicina Universidad de Chile, Santos Dumont 999, Independencia, Santiago Norte, Chile

    C. M. Romero

  3. Department of Neurology, Clinical Hospital, Catholic University of Chile, Santiago Norte, Chile

    A. Reccius

  4. Department of Radiology, Clinical Hospital, University of Chile, Santiago Norte, Chile

    F. Mena & J. Prieto

  5. Department of Neurology and Neurosurgery, Critical Patient Unit, Clinical Hospital, University of Chile, Santiago Norte, Chile

    P. Bustos

  6. Faculty of Medicine, University of Chile, Santiago Norte, Chile

    J. Larrondo

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  1. C. M. Romero
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  2. D. Morales
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  3. A. Reccius
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  4. F. Mena
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  6. P. Bustos
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  7. J. Larrondo
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  8. J. Castro
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Correspondence to C. M. Romero.

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Romero, C.M., Morales, D., Reccius, A. et al. Milrinone as a Rescue Therapy for Symptomatic Refractory Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 11, 165–171 (2009). https://doi.org/10.1007/s12028-008-9048-0

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  • DOI: https://doi.org/10.1007/s12028-008-9048-0

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