The Effect of Milrinone on the Cerebral Vasospasm in Patients with Subarachnoid Hemorrhage

Abstract

Introduction: Cerebrovascular diseases are called brain blood vessel problems. The prevalence of brain aneurysms has been reported to be between 6% and 10%. In cerebral aneurysm, vasospasm is known to be the most important curable cause of mortality. Milrinone is used as inotropic drug to dilate vessels via phosphodiesterase inhibition. Therefore, the purpose of this study was to compare the effectiveness of milrinone for treatment of cerebral vasospasm in patients with subarachnoid hemorrhage. Materials and Methods: This is a clinical and double-blind clinical trial performed on all patients with SAH who formed the target population. Furthermore, CT scans and angiography were performed for all patients. 50 I¼g/ml milrinone was injected initially during digital subtraction angiography (DSA) for patients in intervention group, and followed by an infusion of 0.5 to 0.75 I¼g / kg / min. Angiography was repeated 10 minutes after injection. In the control group, the milrinone drug was not injected. Data was analyzed by software spss 20. Descriptive statistics and t-test were used to analyze the parametric data and, the Chi-square test was used for non-parametric masters. Results: The mean age of patients in the two groups did not show a significant difference (P = 0.974). There was no significant difference between the two groups in terms of GCS, at first (P = 0.809). There was a statistically significant difference between the two groups (GCS) after 24 hours and 14 days, respectively (P = 0.004 and P = 0.011), and GCS in the milrinone group improved over 24 hours and 14 days, indicating a positive effect of milrinone on patients with brain aneurysm. A significant difference was found between the two groups in terms of vasospasm treatment (P = 0.033), where the milrinone group showed better improvement of vasospasm. Regarding the overall improvement, the milrinone group had a better treatment when comparing with the control group, but this difference was not found to be statistically significant (P = 0.078). Conclusion: Milrinone was effective in improving vasospasm in patients, but did not improve the patients' neurological status. Furthermore, GCS in the milrinone group was better than the other group after 24 hours and 14 days.