DOI: 10.14704/nq.2019.17.8.2549

The Effect of Milrinone on the Cerebral Vasospasm in Patients with Subarachnoid Hemorrhage

Alireza Kamali, Reza Mansubi, Mohsen Dalvandi

Abstract


Introduction: Cerebrovascular diseases are called brain blood vessel problems. The prevalence of brain aneurysms has been reported to be between 6% and 10%. In cerebral aneurysm, vasospasm is known to be the most important curable cause of mortality. Milrinone is used as inotropic drug to dilate vessels via phosphodiesterase inhibition. Therefore, the purpose of this study was to compare the effectiveness of milrinone for treatment of cerebral vasospasm in patients with subarachnoid hemorrhage.
Materials and Methods: This is a clinical and double-blind clinical trial performed on all patients with SAH who formed the target population. Furthermore, CT scans and angiography were performed for all patients. 50 μg/ml milrinone was injected initially during digital subtraction angiography (DSA) for patients in intervention group, and followed by an infusion of 0.5 to 0.75 μg / kg / min. Angiography was repeated 10 minutes after injection. In the control group, the milrinone drug was not injected. Data was analyzed by software spss 20. Descriptive statistics and t-test were used to analyze the parametric data and, the Chi-square test was used for non-parametric masters.
Results: The mean age of patients in the two groups did not show a significant difference (P = 0.974). There was no significant difference between the two groups in terms of GCS, at first (P = 0.809). There was a statistically significant difference between the two groups (GCS) after 24 hours and 14 days, respectively (P = 0.004 and P = 0.011), and GCS in the milrinone group improved over 24 hours and 14 days, indicating a positive effect of milrinone on patients with brain aneurysm. A significant difference was found between the two groups in terms of vasospasm treatment (P = 0.033), where the milrinone group showed better improvement of vasospasm. Regarding the overall improvement, the milrinone group had a better treatment when comparing with the control group, but this difference was not found to be statistically significant (P = 0.078).
Conclusion: Milrinone was effective in improving vasospasm in patients, but did not improve the patients' neurological status. Furthermore, GCS in the milrinone group was better than the other group after 24 hours and 14 days.

Keywords


Milrinone, Cerebral vasospasm, Subarachnoid hemorrhage.

Full Text:

PDF

References


Naidech AM, Janjua N, Kreiter KT, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. Arch Neurol. 2005; 6(2): 410.

Ellamushi HE. Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg 2001; 9(4): 728-32.

Iwamoto HY, Fujishima M, Ka to I, Nakayama K, Sueishi K, et al. Prevalence of intracranial saccular aneurysm in a Japanese community based on a consecuative autopsy series during a 30 years observation period: the hisayama period. Stroke. 1999; 3(10): 1390-5.

Juvela S. Risk factors for formation of multiple intracranial aneurisms. SHOCK 2000; 31(2): 125-6.

Mayberg MT, Bark D. Morphologic changes in cerebral arteries after subarachnoid hemorrhage. Neurosurg Clin N Am 1990; 1(2): 417-32.

Wickman GC, Vollrath B. Functional roles of the rho/rho kinase pathway and protein kinas C in the regulation of cerebrovascula constriction mediated by hemoglobin: relevanc to subarachnoid hemorrhage and vasospasm. Circ Res 2003; 92(7): 809-16.

Torbey MT, Bhardwaj A, Williams M, Ulatowski J, Mirski M, et al. Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2001; 32(9): 2005-11.

Saboori M, Bahador MA, Abrishamkar S. Effect of Subarachnoid Injection of Papaverine on Mortality and Morbidity in Patients with Spontaneous Subarachnoid Hemorrhage and Cerebral Vasospasm. Journal of Isfahan Medical School 2009; 29(156): 1312-17.

Juan S, Wei-Jian J. Drug treatment of cerebral vasospasm after subarachnoid hemorrhage following aneurysms. Chinese Neurosurgical Journal 2016; 2(4): 111-5.

Minami HK, Tamaki N. Intraarterial infusion of papaverine and change of cerebral hemodynamics in symptomatic cerebral vasospasm. Kobe J Med Sci 2001; 74(4): 169-79.

Dalbasti TM, Ozdamar N, Oktar N, Cagli S. Efficacy of controlled release papaverine pellets in preventing symptomatic cerebral vasospasm. J Neurosurg 2001; 95(1): 44-50.

Smith WC, Johnston S, Ko N, DeArmond S, Dillon W, et al. Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2004; 35(11): 2518-22.

Lannes M, Zeiler F, Guichon C, Teitelbaum J. The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review. Can J Neurol Sci 2017; 44(2): 152-160.

Li K, Barras CD, Chandra RV, Kok HK, Maingard JT, Carter NS, et al. A review on the management of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. World Neurosurg 2019. pii: S1878-8750(19)30751-X.

Wermer MJ, van der Schaaf IC, Velthuis BK, et al. Follow-up screening after subarachnoid haemorrhage: frequency and determinants of new aneurysms and enlargement of existing aneurysms. Brain 2005; 12(8): 2421-2329.

Ghanem MA. Effects of Milrinone continuous intravenous infusion on global cerebral oxygenation and cerebral vasospasm after cerebral aneurysm surgical clipping. Neurosurgery 2014; 13(8): 99-115.

Sadamasa NK, Narumi O, Chin M, Yamagata S. Milrinone Via Lumbar Subarachnoid Catheter for Vasospasm After Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care 2014; 21(3): 470-5.

Shankar JM, Silva L. Angiographic evaluation of the effect of intra-arterial milrinone therapy in patients with vasospasm from aneurysmal subarachnoid hemorrhage. Neuroradiology 2011; 53(2): 123-8.

Yoshiki A, K-iK, Masato H, et al. Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases. Neurosurgery 2001; 48(4): 723-8.


Supporting Agencies





| NeuroScience + QuantumPhysics> NeuroQuantology :: Copyright 2001-2019