Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures

Article Article scientifique Article Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures eng 2023-12-17 author Bernava Gianmarco 0000-0003-2037-5558 Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 906768 Département de radiologie et informatique médicale (RADIO) author Tesoro Rosa Division of Anesthesia, Geneva University Hospitals, Geneva, Switzerland author Boto Jose Manuel Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 946208 author Challita Myriam Division of Anesthesia, Geneva University Hospitals, Geneva, Switzerland 973925 author Rosi Andréa Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 937431 author Hofmeister Jérémy 0000-0002-0071-8499 Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 643702 author Yilmaz Hasan Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 565252 author Carrera Emmanuel Division of Neurology, Geneva University Hospitals, Geneva, Switzerland 812606 Département des neurosciences cliniques (OTONO) author Brina Aldo Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 552012 author Reymond Philippe Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 702955 author Muster Michel Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 836576 author Kulcsar Zsolt Division of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland 724585 author Lövblad Karl-Olof Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 135154 Département de radiologie et informatique médicale (RADIO) author Machi Paolo Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland 860889 Département de radiologie et informatique médicale (RADIO) 15910199231221510 10.1177/15910199231221510 38105436 1591-0199 http://journals.sagepub.com/doi/10.1177/15910199231221510 Background : Focal vasospasm (FV) of the occluded vessel can occur during the endovascular treatment of acute ischemic stroke (AIS). Nimodipine is commonly used to treat vasospasm and can play a role in distinguishing it from artery narrowing due to iatrogenic dissection or residual clot. However, nimodipine administration can result in arterial hypotension and subsequent enlargement of the ischemic core. Objective : To assess the efficacy of preventive and continuous vasoactive amine infusion to counterbalance nimodipine-induced hypotension. Methods : We reviewed data from a prospective registry of patients treated for AIS between January 2019 and January 2022 who were administered nimodipine. All patients were equipped with an arterial cannula for invasive blood pressure measurement and given vasoactive amines preemptively before general anesthesia and throughout the procedure. Data obtained from invasive monitoring of mean arterial blood pressure (MABP) in a time-lapse of 25 min before and after nimodipine administration were analyzed. Results : MABP significantly decreased after nimodipine administration but remained within the recommended range (81.79 ± 0.49 mmHg). Nimodipine was effective in reducing FV caused by stent retriever passage in 76.3% of cases. Furthermore, it proved valuable in diagnosing iatrogenic dissection (9.2%), residual clot (10.5%), or intracranial stenosis (4%). Conclusions : Infusion of vasoactive amines effectively counteracted the intraarterial nimodipine effect, thus avoiding frank arterial hypotension during endovascular treatment. Nimodipine has been useful in differentiating the diagnosis of FV resulting from mechanical thrombectomy and other potential causes, such as iatrogenic dissection or residual clot. Stroke Nimodipine Stentriever Thrombectomy Vasospasm Dewey 616.8 Dewey 616.0757 Dewey 616 Swiss National Science Foundation Development and experimental evaluation of a novel robotic-assisted mechanical thrombectomy approach for the endovascular treatment of acute ischemic stroke 188942 CH Projects Swiss National Science Foundation Characterizing the intravascular clot in acute stroke with multi-parametric imaging 182382 CH Projects 62 Département de radiologie et informatique médicale 227 56 Département de médecine 221 61 Département des neurosciences cliniques 226 false 470 Ischémie cérébrale et connectivité 801 1339 Développement sur les thérapies endovasculaires du cerveau 1026 1416 Accident vasculaire cérébral 1049 Interventional neuroradiology afb3cd87-c40b-4ac6-bb6d-cd22acc9aeae Article (Published version) Public bernava-et-al-2023-effectiveness-of.pdf 911125 application/pdf CC BY-NC-4.0 9a801be35eabfa2d235db1d2ccf4fb9fdf3775b320812f633d016b67badc4068 openAccess Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures	Interventional neuroradiology			2023	54	121

Archive ouverte UNIGE

Challita, Myriam