Table 7.
Clinical studies involving nimodipine treatment in subarachnoid hemorrhage patients.
| References | Citation | SAH grade | Study size | Nimodipine dose | Placebo? | Primary endopoints | CBF measured? | Critical observations |
|---|---|---|---|---|---|---|---|---|
| Allen et al., 1983 | (225) | Not Defined | 116 (56 treated) | 0.35 mg/kg/4 h | YES | Neurologic, Radiographic | NO | Nimodipine reduced the incidence of severe neurological deficits, including death. Nimodipine reduced vasospasm in patients with severe outcomes, but not normal outcomes. |
| Philippon et al., 1986 | (233) | Hunt-Hess 1-3 | 70 (31 treated) | 60 mg/4 h | YES | Neurologic, Radiographic | NO | Nimodipine reduced neurological deficit severity when vasospasm was present. Nimodipine did not affect the incidence of neurologial deficits or vasospasm. |
| Petruk et al., 1988 | (234) | Hunt-Hess 3-5 | 154 (72 treated) | 90 mg/4 h | YES | Neurologic, Radiographic | NO | Nimodipine improved Glasgow Outcome Scores in Hunt-Hess 3-4 patients. Nimodipine significantly reduced neurological deficits associated with vasospasm. Nimodipine did not influence incidence or severity of vasospasm. |
| Mee et al., 1988 | (235) | All Grades on | 50 (25 treated) | 60 mg/4 h | YES | Neurologic, Radiographic, CBF | YES | Nimodipine reduced mortality, but did not change the proportion of good/poor outcomes. |
| Custom Scale | Nimodipine did not affect the incidence of vasospasm and did not change CBF. | |||||||
| Jan et al., 1988 | (236) | Hunt-Hess 1-5 | 127 (73 treated) | 0.03 mg/kg/h | YES | Neurologic | NO | Nimodipine improved neurological outcome in patients with vasospasm. |
| Pickard et al., 1989 | (237) | Hunt-Hess 1-5 | 554 (278 treated) | 60 mg/4 h | YES | Neurologic, Infarction | NO | Nimodipine reduced cerebral infarcts and poor outcomes; there was a strong tendency for reduced mortality. |
| Messeter et al., 1987 | (238) | Hunt-Hess 1-3 | 20 (13 treated) | topical/i.v. | NO | Neurologic, CBF | YES | Nimodipine did not alter CBF, but it improved neurological outcome. |
| Ohman et al., 1991 | (239) | Hunt-Hess 1-3 | 213 (109 treated) | 0.03 mg/kg/h | YES | Neurologic, Infarction | NO | Nimodipine reduced mortality, but did not change the proportion of good/poor outcome. |
| Nimodipine reduced the incidence of cerebral infarcts and DCI. | ||||||||
| Rasmussen et al., 1999 | (240) | Hunt-Hess 3-5 | 8 (pre/post) | 0.03 mg/kg/h | NO | CBF, autoregulation, CRMO2 | YES | Nimodipine did not alter CBF or autoregulation. Nimodipine may improve CRMO2 during hypotension. |
| Choi et al., 2012 | (241) | Hunt-Hess 3-5 | 16 | 30–60 mg/4 h | NO | MAP, CBF | YES | Each nimodipine dose caused small decreases in MAP and CBF. |
| Hänggi et al., 2008 | (242) | WFNS 1-4 | 26 (pre/post) | Intra-arterial | NO | CBF, radiographic | YES | In patients with severe vasospasm refractory to systemic nimodipine, intra-arterial nimodipine transiently reduced vasospasm and increased perfusion. |
These studies included SAH patients only. CBF, Cerebral blood flow; CRMO2, cerebral metabolic rate of oxygen; DCI, delayed cerebral ischemia; MAP, mean arterial pressure; SAH, Subarachnoid hemorrhage; WFNS, World Federation of Neurosurgical Societies scale.