Therapy of milrinone for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage

OBJECTIVE To assess the safety and effectiveness of milrinone injection in the treatment of cerebral vasospasm in patients with clinical symptoms.METHODS Eight patients diagnosed with aneurysmal subarachnoid hemorrhage who developed symptomatic cerebral vasospasm refractory to conventional medical therapy were enrolled.They received an intra-arterial infusion of milrinone at a rate of 0.25 mg·min-1,with a total dose of 10-15 mg.Qualitative evaluation of angiographic response,neurological and systemic complications as well as functional outcome at 3 months was documented.RESULTS All patients had a significant angiographic response.This was evidenced by a pre-treatment vessel stenosis greater than 70%,which was improved to less than 50% after the intra-arterial milrinone infusion.Three patients developed recurrent vasospasm that was improved after a second intra-arterial milrinone infusion.None of the patients developed neurologic or systemic complications attributed to the intervention.At 3 months follow-up all patients were alive and had a mean modified Rankin scale of 2±1 and a Barthel index of 83±10.CONCLUSION Intra-arterial milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.