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Rofo 2023; 195(11): 1018-1026
DOI: 10.1055/a-2102-0129
Neuroradiology

Evaluation of DeGIR registry data on endovascular treatment of cerebral vasospasm in Germany 2018–2021: an overview of the current care situation

Article in several languages: English | deutsch
Alexander Neumann 
1   Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
,
Werner Weber
2   Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany
,
Jan Küchler
3   Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
,
Hannes Schacht
1   Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
,
Ulf Jensen-Kondering
1   Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
,
Ansgar Berlis
4   Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany
,
Peter Schramm
1   Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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Abstract

Background Evaluation of endovascular therapies for cerebral vasospasm (CVS) documented in the DeGIR registry from 2018–2021 to analyse the current clinical care situation in Germany.

Methods Retrospective analysis of the clinical and procedural data on endovascular spasm therapies (EST) documented anonymously in the DeGIR registry. We analysed: pre-interventional findings of CTP and consciousness; radiation dose applied, interventional-technical parameters (local medication, devices, angiographic result), post-interventional symptoms, complications and mortality.

Results 3584 patients received a total of 7628 EST (median age/patient: 53 [range: 13–100, IQR: 44–60], 68.2 % women) in 91 (2018), 92 (2019), 100 (2020) and 98 (2021) centres; 5388 (70.6 %) anterior circulation and 378 (5 %) posterior circulation (both involved in 1862 cases [24.4 %]). EST was performed once in 2125 cases (27.9 %), with a mean of 2.1 EST/patient. In 7476 times, purely medicated EST were carried out (nimodipine: 6835, papaverine: 401, nitroglycerin: 62, other drug not specified: 239; combinations: 90). Microcatheter infusions were documented in 1132 times (14.8 %). Balloon angioplasty (BA) (additional) was performed in 756 EST (9.9 %), other mechanical recanalisations in 154 cases (2 %) and stenting in 176 of the EST (2.3 %). The median dose area product during ET was 4069 cGycm² (drug: 4002/[+]BA: 8003 [p < 0.001]). At least 1 complication occurred in 95 of all procedures (1.2 %) (drug: 1.1 %/[+]BA: 4.2 % [p < 0.001]). Mortality associated with EST was 0.2 % (n = 18). After EST, overall improvement or elimination of CVS was found in 94.2 % of cases (drug: 93.8 %/[+]BA: 98.1 % [p < 0.001]). In a comparison of the locally applied drugs, papaverine eliminated CVS more frequently than nimodipine (p = 0.001).

Conclusion EST have a moderate radiation exposure and can be performed with few complications. Purely medicated EST are predominantly performed, especially with nimodipine. With (additional) BA, radiation exposure, complication rates and angiographic results are higher or better. When considering drug EST alone, there is evidence for an advantage of papaverine over nimodipine, but a different group size has to be taken into account. In the analysis of EST, the DeGIR registry data are suitable for answering more specific questions, especially due to the large number of cases; for this purpose, further subgroupings should be sought in the data documentation.

Key points: 

  • In Germany, there are currently no guidelines for the endovascular treatment of cerebral vasospasm following spontaneous subarachnoid hemorrhage.

  • In addition to oral nimodipine administration endovascular therapy is used to treat cerebral vasospasm in most hospitals.

  • This is the first systematic evaluation of nationwide registry data on endovascular treatment of cerebral vasopasm in Germany.

  • This real-world data shows that endovascular treatment for cerebral vasospasm has a moderate radiation exposure and can be performed with few complications overall. With (additional) balloon angioplasty, radiation exposure, complication rates and angiographic therapy results are higher or better.

Citation Format

  • Neumann A, Weber W, Küchler J et al. Evaluation of DeGIR registry data on endovascular treatment of cerebral vasospasm in Germany 2018–2021: an overview of the current care situation. Fortschr Röntgenstr 2023; 195: 1018 – 1026

Key words

subarachnoid hemorrhage - cerebral vasospasm - endovascular rescue treatment - nimodipine - balloon angioplasty


Publication History

Received: 27 February 2023

Accepted: 25 May 2023

Article published online:
19 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 de Rooij NK, Linn FH, van der Plas JA. et al. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007; 78 (12) 1365-1372
    CrossrefPubMedGoogle Scholar
  • 2 Dorsch NW, King MT. A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage Part I: Incidence and effects. J Clin Neurosci 1994; 1 (01) 19-26
    CrossrefPubMedGoogle Scholar
  • 3 Li K, Barras CD, Chandra RV. et al. A Review of the Management of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 126: 513-527
    CrossrefPubMedGoogle Scholar
  • 4 Vergouwen MD, Vermeulen M, van Gijn J. et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 2010; 41 (10) 2391-2395
    CrossrefPubMedGoogle Scholar
  • 5 Connolly Jr ES, Rabinstein AA, Carhuapoma JR. American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology. et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43 (06) 1711-1137
    CrossrefPubMedGoogle Scholar
  • 6 Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 2016; 20 (01) 277
    CrossrefPubMedGoogle Scholar
  • 7 Hänggi D, Turowski B, Beseoglu K. et al. Intra-arterial nimodipine for severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage: influence on clinical course and cerebral perfusion. AJNR Am J Neuroradiol 2008; 29 (06) 1053-1060
    CrossrefPubMedGoogle Scholar
  • 8 Mielke D, Döring K, Behme D. et al. The Impact of Endovascular Rescue Therapy on the Clinical and Radiological Outcome After Aneurysmal Subarachnoid Hemorrhage: A Safe and Effective Treatment Option for Hemodynamically Relevant Vasospasm?. Front Neurol 2022; 13: 838456
    CrossrefPubMedGoogle Scholar
  • 9 Carlson AP, Hänggi D, Macdonald RL. et al. Nimodipine Reappraised: An Old Drug With a Future. Curr Neuropharmacol 2020; 18 (01) 65-82
    CrossrefPubMedGoogle Scholar
  • 10 Walter J, Grutza M, Möhlenbruch M. et al. The Local Intraarterial Administration of Nimodipine Might Positively Affect Clinical Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage and Delayed Cerebral Ischemia. J Clin Med 2022; 11 (07) 2036
    PubMedGoogle Scholar
  • 11 Hasegawa S, Hasegawa Y, Miura M. Current Therapeutic Drugs Against Cerebral Vasospasm after Subarachnoid Hemorrhage: A Comprehensive Review of Basic and Clinical Studies. Curr Drug Deliv 2017; 14 (06) 843-852
    CrossrefPubMedGoogle Scholar
  • 12 Schacht H, Küchler J, Boppel T. et al. Transluminal balloon angioplasty for cerebral vasospasm after spontaneous subarachnoid hemorrhage: A single-center experience. Clin Neurol Neurosurg 2019; 188: 105590
    CrossrefPubMedGoogle Scholar
  • 13 Kapapa T, König R, Mayer B. et al. Adverse Events and Complications in Continuous Intra-arterial Nimodipine Infusion Therapy After Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2022; 12: 812898
    CrossrefPubMedGoogle Scholar
  • 14 Hensler J, Wodarg F, Madjidyar J. et al. Efficacy and safety in the use of stent-retrievers for treatment of cerebral vasospasms after subarachnoid hemorrhage. Interv Neuroradiol 2022; DOI: 10.1177/15910199221086389.
    CrossrefPubMedGoogle Scholar
  • 15 Salem MM, Khalife J, Desai S. et al COManeci MechANical dilation for vasospasm (COMMAND): multicenter experience. J Neurointerv Surg 2022; DOI: 10.1136/jnis-2022-019272. Epub ahead of print.
    CrossrefPubMedGoogle Scholar
  • 16 Khanafer A, Cimpoca A, Bhogal P. et al. Intracranial stenting as a bail-out option for posthemorrhagic cerebral vasospasm: a single-center experience with long-term follow-up. BMC Neurol 2022; 22 (01) 351
    CrossrefPubMedGoogle Scholar
  • 17 Deutsche Gesellschaft für Neurologie (DGN). S1-Leitlinie Subarachnoidalblutung (SAB) (Version 4.0 der [online]), 30.09.2012. Verfügbar unter (Zugriff am 24.02.2023): https://register.awmf.org/de/leitlinien/detail/030-073
    PubMedGoogle Scholar
  • 18 Berlis A, Morhard D, Weber W. On the Basis of the DeGIR/DGNR Register Nationwide Care for Acute Ischemic Stroke Patients in 2016 and 2017 Using Mechanical Thrombectomy by Radiologists and Neuroradiologists. Fortschr Röntgenstr 2019; 191 (07) 613-617
    PubMedGoogle Scholar
  • 19 Rohde S, Weber W, Berlis A. et al. Acute Endovascular Stroke Treatment in Germany in 2019. Clin Neuroradiol 2021; 31: 11-19
    CrossrefPubMedGoogle Scholar
  • 20 Ditz C, Neumann A, Wojak J. et al. Repeated endovascular treatments in patients with recurrent cerebral vasospasms after subarachnoid hemorrhage: a worthwhile strategy?. World Neurosurg 2018; 112: e791-e798
    CrossrefPubMedGoogle Scholar
  • 21 Opitz M, Zensen S, Bos D. et al. Radiation exposure in the intra-arterial nimodipine therapy of subarachnoid hemorrhage related cerebral vasospasm. J Radiol Prot 2022; 42 (01) DOI: 10.1088/1361-6498/ac32a2.
    CrossrefPubMedGoogle Scholar
  • 22 Jabbarli R, Pierscianek D, Rölz R. et al. Endovascular treatment of cerebral vasospasm after subarachnoid hemorrhage: More is more. Neurology 2019; 93 (05) e458-e466
    CrossrefPubMedGoogle Scholar
  • 23 Adami D, Berkefeld J, Platz J. et al. Complication rate of intraarterial treatment of severe cerebral vasospasm after subarachnoid hemorrhage with nimodipine and percutaneous transluminal balloon angioplasty: Worth the risk?. J Neuroradiol 2019; 46 (01) 15-24
    CrossrefPubMedGoogle Scholar
  • 24 Jentzsch J, Ziganshyna S, Lindner D. et al. Nimodipine vs. Milrinone – Equal or Complementary Use? A Retrospective Analysis. Front Neurol 2022; 13: 939015
    CrossrefPubMedGoogle Scholar
  • 25 Sherif C, Wambacher B, Loyoddin M. et al. Repeated combined endovascular therapy with milrinone and nimodipine for the treatment of severe vasospasm: preliminary results. Acta Neurochir Suppl 2015; 120: 203-207
    CrossrefPubMedGoogle Scholar
  • 26 https://www.g-ba.de/bewertungsverfahren/methodenbewertung/264/ (Zugriff am 24.02.2023).
    PubMed
  • 27 Kerz T, Boor S, Beyer C. et al. Effect of intraarterial papaverine or nimodipine on vessel diameter in patients with cerebral vasospasm after subarachnoid hemorrhage. Br J Neurosurg 2012; 26 (04) 517-524
    CrossrefPubMedGoogle Scholar
  • 28 Nadjiri J, Geith T, Waggershauser T. et al Comparison of radiation exposure in common hepatic interventions: A retrospective analysis of DeGIR registry data. Radiologe 2021; 61 (01) 80-86 DOI: 10.1007/s00117-020-00737-8. German. PMID: 32816049; PMCID: PMC7810650.
    CrossrefPubMedGoogle Scholar
  • 29 Göttsche J, Piffko A, Pantel TF. et al. Aneurysm Location Affects Clinical Course and Mortality in Patients With Subarachnoid Hemorrhage. Front Neurol 2022; 13: 846066
    CrossrefPubMedGoogle Scholar
  • 30 Cole TS, Rudy RF, Faridmoayer E. et al Relationship between cerebral vasospasm vascular territory and functional outcome after aneurysmal subarachnoid hemorrhage. J Neurointerventional Surg 2022; DOI: 10.1136/jnis-2022-019016. Epub ahead of print.
    CrossrefPubMedGoogle Scholar