Article Figures & Data
Figures
- Fig 1.
Patient 10: an aneurysm of the left anterior choroidal artery. Angiogram obtained at anterior-posterior projection (A) shows a diffuse vasospasm involving the terminal internal carotid artery (ICA), the A1 and A2 segments of the anterior cerebral artery (ACA), and the M1 and M2 segments of the middle cerebral artery (MCA). Ten minutes later, after intra-arterial infusion of 1.5 mg of nimodipine, an angiogram at the same projection (B) shows slight improvement but still diffuse vasospasm. After the end of the embolization, under continuous nimodipine infusion at the dose of 1 mg per hour (total, 2 mg), an angiogram (C) shows significant vasorelaxation.
- Fig 2.
Patient 2: an aneurysm of the right posterior communicating artery. An angiogram obtained at the right anterior oblique projection (A) shows a vasospasm at the supraclinoid ICA, the A1 and A2 segments of the ACA, and the M1 and M2 segments of the MCA. Fourteen minutes later, after intra-arterial infusion of 2 mg of nimodipine, this angiogram (B) shows some degree of vasorelaxation, especially in the proximal segments of the ACA. Final angiogram at the same projection after completion of embolization (C), with continuous intra-arterial infusion of 1.5 mg of nimodipine throughout the procedure, demonstrates complete disappearance of the proximal vasospasm and near-complete clearance of the distal spasm as well as occlusion of the aneurysm.
Tables
Summary of our 10 patients
No./Age/Sex Aneurysm HH Grade Days After SAH Vasospasm Symptom Spastic Segment Vasospasm Arterial Nimodipine (mg) Aneurysmal Occlusion mRS Follow-up (yrs/mos) Before After Bolus Infusion 1/55/F Basilar tip 3 8 + BA, Bilateral diffuse ICA Mo, Se Co, –* 1 0.75 Incomplete 1 3 yrs 2/45/F PcomA 4 7 + RICA, RA1-A2, RM1-M2 Mo, Se, Se Co, Mi, Mi 2 1.5 Neck remnant 3 2 yrs 3/50/F Ophthalmic 3 7 + RICA, RM1 Se, Se Mo, Mi 2 1 Complete 3 3 yrs 4/35/F Basilar tip 3 6 − BA, bilateral P1-P2 Mo, Se Co, Mi 1 1.75 Neck remnant 2 6 mos 5/65/M AcomA 5 14 + Bilateral A1 and A2 Mo Co 1 1 Incomplete Died – 6/79/F AcomA 3 9 + LA1, bilateral A2 Se, Se Co, Co 1.75 1 Incomplete 2 1 yr 7/45/M AcomA 4 4 − LA1, LA2 Se, Mi Co, Co 1.5 1 Complete 3 6 mos 8/35/M AcomA 5 11 + LA1, bilateral A2 Mo, Mo Co, Mi 1 1.25 Complete Died – 9/42/F SCA 3 8 − BA, bilateral P1-P2 Se, Se Mo, Mo 1 1.5 Complete 2 6 mos 10/38/F AchoA 3 13 + LICA, LA1-A2, LM1-M2 Mo, Se, Se Co, Mi, Mi 1.5 2 Complete 3 6 mos Note:—HH indicates Hunt and Hess; SAH, subarachnoid hemorrhage; mRS, Modified Rankin Score; BA, basilar artery; AcomA, anterior communicating artery; PcomA, posterior communicating artery; SCA, superior cerebellar artery; AchoA, anterior choroidal artery; ICA, internal carotid artery; LICA, left internal carotid artery; RICA, right internal carotid artery; Mi, mild; Mo, moderate; Se, severe; Co, complete dilation (<10% spasm).
* Not determined.
