METHOD FOR TREATMENT OF CEREBRAL VASOSPASM IN ANEURYSMAL SUBARACHNOID HEMORRHAGE

摘要

FIELD: medicine. ;SUBSTANCE: invention relates to medicine, namely to neurosurgery, vascular surgery, neurology, and can be used for X-ray endovascular chemo-angioplasty for the treatment of cerebral vasospasm in aneurysmal subarachnoid hemorrhage. A microcatheter is inserted into the cerebral arteries, through which 10 or 20 mg of Nimotop diluted in 500 or 1000 ml of 0.9% NaCl solution, respectively, from a dark glass container, is superselectively injected into the cerebral pool, through a standard system for intravenous infusions, at a rate of one drop per second using high-pressure cuffs coupled with a diagnostic catheter. With a decrease in blood pressure, the introduction of vasopressors is indicated, with the ineffectiveness of which and an uncontrolled decrease in blood pressure, the infusion rate of the drug Nimotop must be reduced, and the systolic blood pressure level should be maintained within 130-150 mm Hg. The decision to complete X-ray endovascular chemo-angioplasty is taken with a decrease in the linear blood flow rate of less than 200 cm/s without signs of increasing cerebral vasospasm during control cerebral angiography. With cerebral vasospasm in the right and/or left carotid basin, a diagnostic catheter is inserted into the middle third of one of the internal carotid arteries. With the development of vasospasm with stenosis of the lumen of one or more cerebral arteries to more than 70%, 2 vials of Nimotop solution (20 mg) are injected, diluted each in 500 ml of 0.9% NaCl. If vasospasm with cerebral artery stenosis is less than 70%, 1 vial is injected. Thus, either 10 mg or 20 mg of Nimotop is administered for 15-20 minutes by drop infusion. Next, the catheter is reinstalled into the contralateral internal carotid artery and the patient is transferred to the intensive care unit, where the final dose of the drug Nimotop is administered with constant monitoring of evaluation criteria: blood pressure, heart rate, linear blood flow rates. The maximum dose of the administered Nimotop for 1 session does not exceed 20 mg. When detecting cerebral spasm in the vertebrobasilar system, X-ray endovascular chemo-angioplasty is performed in the vertebrobasilar system according to the proposed scheme through a diagnostic catheter installed in the middle third of the dominant vertebral artery, through which, with the development of vasospasm with stenosis of the lumen of one or more cerebral arteries to more than 70%, 2 vials of Nimotop solution (20 mg), diluted each in 500 ml 0.9% NaCl are selectively injected. If vasospasm with cerebral artery stenosis is less than 70%, 1 vial is injected. Thus, either 10 mg or 20 mg of Nimotop is administered with constant monitoring of evaluation criteria: blood pressure, heart rate, linear blood flow rates. The maximum dose of the administered Nimotop for 1 session does not exceed 20 mg. ;EFFECT: method provides the possibility of reducing surgical injury while maintaining a high degree of effectiveness in the treatment of cerebral vasospasm with aneurysmal subarachnoid hemorrhage due to the proposed method of X-ray endovascular chemo-angioplasty. ;1 cl, 12 dwg, 2 ex