UPmémoires

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Interest in the use of milrinone in secondary prevention of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

Introduction: Cerebral vasospasm (CVS) following aneurysmal subarachnoid hemorrhage (ASAH) is a significant cause of morbidity and mortality. We decided to study the benefit of milrinone in the secondary prevention of CVS in patients who have experienced an ASAH.

Materials and methods: We performed a retrospective review of patients with ASAH admitted in the University Hospital of Poitiers between January 2012 and December 2023. We decided to study patients in two groups: one before the implementation of milrinone in our monitoring protocol in 2015, and another group after. Baseline characteristics, treatment and radiological outcomes were compared between the two groups. A multivariable Cox proportional hazard model was used to model the hazard rate of getting an endovascular treatment and a multivariable weighted logistic regression incorporating spasm levels, age and sex as covariates in the model was used to estimate DCI risk before and after 2015.

Results: 73 patients were included in the group before milrinone and 409 in the group after. We observed a significant reduction of endovascular treatment rate since the introduction of milrinone in our protocol (reduction of 56%, p <0.001). Moreover, we found a statistically significant decreasing in the onset of DCI over the years, which shows that the fall in the use of endovascular treatment has not led to an increase in ischemic complications.

Conclusion: This study suggests that milrinone can reduce the incidence of therapeutic angiographies for CVS and prevent the onset of cerebral ischemia after ASAH.

Keywords : Aneurysm, Subarachnoid hemorrhage, Cerebral vasospasm, Angioplasty, Milrinone, Delayed cerebral ischemia.