Side effects of continuous intra-arterial infusion of nimodipine for management of resistant cerebral vasospasm in subarachnoid hemorrhage patients: A systematic review

• Published in: Neuro-chirurgie 2021-09, Vol.67 (5), p.461-469
• Main Authors: Viderman, D., Sarria-Santamera, A., Bilotta, F.
• Format: Article
• Language: English
• Subjects: Complication; Effet secondaire intra-artériel; hémorragie sous-arachnoïdienne; Intra-arterial; Nimodipine; Side-effect; Subarachnoid hemorrhage; Vasospasm; Vasospasme
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2021.02.005

Cerebral vasospasm is a common complication of subarachnoid hemorrhage. Nimodipine is the most frequently used drug for cerebral vasospasm management and is the only approved medication that has been demonstrated to reduce ischemic complications, infarct size and improve neurological outcome after aneurismal subarachnoid hemorrhage. The main purpose of this systematic review was to conduct a comprehensive analysis of the main cerebral and extracerebral side effects of continuous intra-arterial infusion of nimodipine in management of delayed cerebral ischemia in subarachnoid hemorrhage patients. A protocol with the inclusion and exclusion criteria for matched cases and the method of analysis were established and agreed by all authors. We defined the scope of this review to include articles (prospective and retrospective) reporting the side effects of continuous intra-arterial infusion of nimodipine in human subjects. PRISMA guidelines were used to conduct this systematic review. A total of 8 articles reporting 136 patients were included in the review and analyzed. The side effects associated with continuous intra-arterial infusion of nimodipine were arterial hypotention, heparin-induced thrombocytopenia, atrial fibrillation or flutter, infections, acute kidney injury, hepatic and gastro-intestinal side effects. The most frequent side effects reported in the articles included in this systematic review associated with the continuous intra-arterial infusion of nimodipine were arterial hypotension and heparin-induced thrombocytopenia. Intracerebral hemorrhage, the elevation of ICP, heart rhythm disorders, infectious complications, and thrombosis of the catheter might be also associated with CIAN. Future prospective studies are warranted to establish the risks and incidence of procedure-related side effects. Le vasospasme cérébral est une complication fréquente de l’hémorragie sous-arachnoïdienne. La nimodipine est le médicament le plus fréquemment utilisé pour la gestion du vasospasme cérébral et est le seul médicament approuvé dont il a été démontré qu’il réduit les complications ischémiques, la taille de l’infarctus et améliore le résultat neurologique après une hémorragie sous-arachnoïdienne anévrismale. Le principal objectif de cette revue systématique était de mener une analyse complète des principaux effets secondaires cérébraux et extracérébraux de la perfusion intra-artérielle continue de nimodipine dans la prise en charge de l’ischémie cérébrale retard