Clinical Experience of Selective Intra-Arterial Nimodipine Treatment for Cerebral Vasospasm Following Subarachnoid Hemorrhage

We read with interest the recent report by Firat et al entitled “Selective Intraarterial Nimodipine Treatment in an Experimental Subarachnoid Hemorrhage Model.”¹ Nimodipine, a calcium channel blocker, is used orally and intravenously for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. In their article, the authors report the effects of selective intra-arterial nimodipine infusion in the treatment of experimentally induced cerebral vasospasm in a rabbit model. We congratulate the authors for their article but disagree with their claim that there are no experimental or clinical studies investigating the effects of intra-arterial nimodipine infusion. In the June 2004 issue of the AJNR,² we published the first preliminary clinical and angiographic results in a series of 25 consecutive patients treated with selective intra-arterial nimodipine for symptomatic aneurysmal cerebral vasospasm. There is a paucity of data available on this topic, and the contribution of Firat et al is appreciated by all of us in the field. However, readers would have benefited more from their work had they been informed of our prior article because they would have known that similar results had been achieved by independent investigators. Knowledge that the experimental work of Firat et al confirmed earlier clinical work would give physicians additional confidence in this important therapeutic option in aneurysmal cerebral vasospasm.