Nimodipine treatment in poor-grade aneurysm patients

• DOI: 10.3171/jns.1988.68.4.0505
• Publication Date: 2009-05-08T16:17:34Z
• Authors: Kenneth C. Petruk; Michael West; Gerard Mohr; Bryce K. A. Weir; Brien G. Benoit; Fred Gentili; Lew B. Disney; Moe I. Khan; Michael Grace; Renn O. Holness; Melinda S. Karwon; Robert M. Ford; G. Stuart Cameron; William S. Tucker; G. Barrie Purves; Jack D. R. Miller; K. Michael Hunter; Michael T. Richard; Felix A. Durity; Richard Chan; Lawrence J. Clein; Falah B. Maroun; Alain Godon
• Keywords: Adult; Clinical Trials as Topic; Adolescent; Intracranial Aneurysm; Cerebral Infarction; Middle Aged; Subarachnoid Hemorrhage; Severity of Illness Index; Antifibrinolytic Agents; Brain Ischemia; Cerebral Angiography; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Double-Blind Method; Ischemic Attack, Transient; Humans; Nimodipine; Tomography, X-Ray Computed; Aged

✓ A multicenter, randomized placebo-controlled double-blind trial of nimodipine in poor-grade aneurysm patients was carried out in 17 Canadian hospitals. Of 188 patients enrolled in the trial, 32 were excluded for protocol violations and two were excluded due to statistical considerations, leaving 154 patients for valid outcome analysis. Nimodipine treatment was associated with a significantly better outcome (p < 0.001): 21 (29.2%) of 72 nimodipine-treated patients had a good outcome at 3 months after subarachnoid hemorrhage (SAH) compared to eight (9.8%) of 82 placebo-treated patients. Delayed ischemic deficits from vasospasm alone were significantly less frequent in the nimodipine group (p < 0.05) with permanent deficits occurring in five nimodipine-treated patients (6.9%) and in 22 placebo-treated patients (26.8%). Improvement in the good outcome rate and reduction in delayed ischemic deficits from vasospasm alone occurred in both Grade 3 and 4 patients, with no difference between nimodipine- and placebo-treated patients being found in Grade 5 patients. Repeat angiography after Day 4 was carried out in 124 patients. There was no significant difference in the incidence of moderate or severe diffuse spasm, which was seen in 64.3% of nimodipine-treated patients and 66.2% of placebo-treated patients. The authors conclude that nimodipine treatment in poor-grade patients with SAH results in an increase in the number of good outcomes and a reduction in the incidence of delayed neurological deterioration due to vasospasm. This effect occurs by a mechanism other than prevention of large-vessel spasm as visualized on angiography.