Nimodipine vs. Milrinone – Equal or Complementary Use? A Retrospective Analysis

Figures

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  Figure 1. Ten measured points. (A) Posterior-anterior projection of an internal carotid artery angiogram, C7 terminal segment of the internal carotid artery, nC7 narrowest point of C7, pM1 proximal horizontal segment of the middle cerebral artery, dM1 distal horizontal segment of the middle cerebral artery, M2 insular segment of the middle cerebral artery, pA1 proximal pre-communication segment of the anterior cerebral artery, dA1 distal pre-communication segment of the anterior cerebral artery, A2 post-communicating segment of the anterior cerebral artery. (B) Lateral projection of an internal carotid artery angiogram, C5 clinoid segment of the internal carotid artery, C6 ophthalmic segment of the internal carotid artery. In lateral projection: C5: 2 mm proximal to the origin of the ophthalmic artery and C6: at the origin of the ophthalmic artery. In posterior-anterior projection: C7: 2 mm proximal to the carotid T, nC7: the narrowest location in vasospastic arteries of C7 segments, pM1: 2 mm distal to carotid T, dM1: 2 mm proximal to middle cerebral artery bifurcation, M2: 4 mm distal to the M1/M2 transition, pA1: 2 mm distal to carotid T, dA1: 2 mm proximal to change of course and A2: 2…

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  Figure 2. Box plot of diameter differences. The difference in vessel diameters (in mm) under pharmacological spasmolysis is depicted for each measured point (see Figure 1). Orientation lines in the neutral zone (continuous) and 0.2 mm difference (dashed) are given in each box plot. (A): nimodipine, (B): milrinone, (C): nimodipine and milrinone.

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  Figure 3. Mosaic plot of both endpoints. Delayed cerebral ischemia (DCI)-related infarctions and the outcome in modified Rankin Scale (mRS) score after 6 months were chosen as study endpoints. (A): DCI-related infarction before and after intraarterial spasmolysis due to the applied spasmolytic agent is shown. One case was excluded for DCI analysis due to missing prespasmolytic CT. The minority of cases (20.7%) already experienced DCI before intra-arterial spasmolysis. Nimodipine and the combination of milrinone and nimodipine revealed the same proportion of DCI (57.1%). In most cases (87.5%), the monotherapy with intra-arterial milrinone could not prevent DCI-related infarctions. (B): The outcome was subdivided into favorable (mRS 0–3) and unfavorable (mRS 4–6). Patients who received nimodipine only had the best outcome after 6 months assessed by mRS, followed by only milrinone-treated patients and patients after combined therapy. N = nimodipine, M = milrinone, NM = nimodipine and milrinone.