Background

Patients with cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage (aSAH) are often treated with intra-arterial (IA) vasodilator infusion. However, the optimal drug regimen is yet to be elucidated.

Methods

A retrospective review of patients with aSAH and cerebral vasospasm treated with IA vasodilator infusion was performed. Patients in group 1 (2008–2011) were treated with a single agent, either nicardipine or verapamil, and patients in group 2 (2010–2016) were treated with a regimen of nitroglycerin, verapamil, and nicardipine. The post-infusion improvement ratio (PIIR) was compared between groups. Adjusted multivariate logistic regression models were utilized to determine whether patients treated with multiple vasodilators had an improved functional outcome, defined by the modified Rankin Scale, at discharge and 90-day follow-up.

Results

Among 116 patients from group 1 (N = 47) and group 2 (N = 69), the median age was 54.5 years [IQR, 46–53 years] and 78% were female. Use of multiple-agent therapy resulted in a 24.36% improvement in vessel diameter over single-agent therapy (median PIIR: group 1, 10.5% [IQR, 5.3–21.1%] vs group 2, 34.9% [IQR, 21.4–66.0%]; p < 0.0001). In the adjusted multivariate logistic regression, the use of multiple-agent therapy was associated with a better functional outcome at discharge (OR 0.15, 95% CI [0.04–0.55]; p < 0.01) and at 90-day follow-up (OR 0.20, 95% CI [0.05–0.77]; p < 0.05) when compared to single-agent therapy.

Conclusion

In this study, we found that patients treated for cerebral vasospasm with IA infusion of multiple vasodilators had an increased vessel response and better functional outcomes compared to those treated with a single agent.

中文翻译：

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在血管痉挛的治疗中使用单一或多种血管舒张药：好于少？

背景

由动脉瘤性蛛网膜下腔出血（aSAH）引起的脑血管痉挛的患者通常接受动脉内（IA）血管扩张剂输注治疗。然而，最佳药物方案尚待阐明。

方法

回顾性分析了接受IA血管扩张剂输注治疗的aSAH和脑血管痉挛的患者。第1组（2008-2011年）的患者接受单一药物尼卡地平或维拉帕米治疗，第2组（2010-2016年）的患者接受硝酸甘油，维拉帕米和尼卡地平治疗。比较各组的输注后改善率（PIIR）。调整后的多元逻辑回归模型用于确定出院时和出院后90天的随访中，使用多种血管扩张剂治疗的患者是否具有改善的功能结局（由改良的Rankin量表定义）。

结果

在第1组（N = 47）和第2组（N = 69）的116例患者中，中位年龄为54.5岁[IQR，46-53岁]，女性占78％。与单药治疗相比，采用多药治疗可使血管直径改善24.36％（中位PIIR：第1组为10.5％[IQR，5.3–21.1％]，而第2组为34.9％[IQR，21.4–66.0％ ]；p <0.0001）。在校正后的多元逻辑回归中，多药疗法的使用与出院时更好的功能结局相关（OR 0.15，95％CI [0.04-0.55]；p <0.01）和90天随访时（OR与单药治疗相比，CI为0.20，95％CI [0.05-0.77；p <0.05）。

结论

在这项研究中，我们发现与单药治疗相比，IA输注多种血管扩张剂治疗脑血管痉挛的患者血管反应增强，功能结局更好。