Abstract Details

Title Analyzing Nimodipine-Associated Hemodynamic and Electrophysiologic Changes and Functional Outcomes in Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-018

Objective To characterize the effects of nimodipine administration on cerebral autoregulation, quantitative electroencephalography (qEEG), and functional outcomes.

Background Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition after which patients are at risk for vasospasm and delayed cerebral ischemia (DCI). Nimodipine, a calcium channel blocker, is used to reduce the risk of DCI. However, its potentially harmful effects on cerebral physiology remain incompletely understood.

Design/Methods Nimodipine-associated blood pressure (BP) reductions were quantified as the difference between median BP in the hour before and minimum BP in the hour after nimodipine. Autoregulatory function was measured by analyzing changes in near-infrared spectroscopy-derived tissue oxygenation in response to changes in mean arterial pressure (MAP). The resulting autoregulatory index was used to determine the upper and lower limits of autoregulation (ULA, LLA) in each patient. Cortical activity was measured by computing percent changes in each qEEG frequency band in the anterior and middle cerebral vascular regions. Patients were dichotomized into good and poor outcome groups by modified Rankin Scale >3 at 3 months and compared using an independent samples t-test.

Results We identified 265 occurrences of nimodipine administration with simultaneous recording of continuous EEG and physiologic data among 21 aSAH patients with median (IQR) age 59 (51, 61) years, Hunt Hess 3 (2, 4), and modified Fisher 4 (3, 4). Patients with good outcome had a greater increase in alpha power after nimodipine compared to those with poor outcome (+4% vs. -0.9%, p = 0.02) and spent less time below LLA (7% vs. 19%, p < 0.001) despite having similar average BP reductions (15 mmHg vs. 14 mmHg, p = 0.488).

Conclusions Nimodipine-associated BP reductions are associated with changes in autoregulation and electrophysiology that differ based on patient outcomes. Prolonged hypoperfusion below the LLA with no alpha power improvement may contribute to adverse effects in these patients.

Authors/Disclosures
Sithmi M. Jayasundara PRESENTER	Miss Jayasundara has nothing to disclose.
Rachel S. Choi (Yale School of Medicine)	Ms. Choi has nothing to disclose.
Amedeo Rapuano (Yale New Haven Hospital)	Amedeo Rapuano has nothing to disclose.
Yilun Chen (Yale University)	Ms. Chen has nothing to disclose.
Ilayda Top (Yale University)	Ms. Top has nothing to disclose.
Madelynne Olexa	Miss Olexa has nothing to disclose.
Rafael Maarek	Mr. Maarek has received research support from National Heart Lung & Blood Institute. Mr. Maarek has received research support from Richard K. Gershon Endowed Medical Student Research Fellowship.
Jennifer Yan	No disclosure on file
David J. Vargas Estrella	Mr. Vargas Estrella has nothing to disclose.
Jessica Magid-Bernstein, MD, PhD (Yale School of Medicine)	Dr. Magid-Bernstein has nothing to disclose.
Abdelaziz Amllay, MD	Dr. Amllay has nothing to disclose.
Lena O'Keefe, MD	Dr. O'Keefe has nothing to disclose.
Ryan Hebert	Ryan Hebert has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus .
Farhad Bahrassa (Yale Department of Neurosurgery)	Farhad Bahrassa has nothing to disclose.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Rachel Beekman, MD (Yale New Haven Medical Center)	Dr. Beekman has nothing to disclose.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.

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