3 results on '"Abulhasan YB"'
Search Results
2. Treatment of Subarachnoid Hemorrhage-associated Delayed Cerebral Ischemia With Milrinone: A Review and Proposal.
- Author
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Bernier TD, Schontz MJ, Izzy S, Chung DY, Nelson SE, Leslie-Mazwi TM, Henderson GV, Dasenbrock H, Patel N, Aziz-Sultan MA, Feske S, Du R, Abulhasan YB, and Angle MR
- Subjects
- Humans, Milrinone therapeutic use, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Brain Ischemia complications, Brain Ischemia drug therapy, Subarachnoid Hemorrhage complications, Subarachnoid Hemorrhage drug therapy, Vasospasm, Intracranial drug therapy, Vasospasm, Intracranial etiology
- Abstract
Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage continues to be associated with high levels of morbidity and mortality. This complication had long been thought to occur secondary to severe cerebral vasospasm, but expert opinion now favors a multifactorial etiology, opening the possibility of new therapies. To date, no definitive treatment option for DCI has been recommended as standard of care, highlighting a need for further research into potential therapies. Milrinone has been identified as a promising therapeutic agent for DCI, possessing a mechanism of action for the reversal of cerebral vasospasm as well as potentially anti-inflammatory effects to treat the underlying etiology of DCI. Intra-arterial and intravenous administration of milrinone has been evaluated for the treatment of DCI in single-center case series and cohorts and appears safe and associated with improved clinical outcomes. Recent results have also brought attention to the potential outcome benefits of early, more aggressive dosing and titration of milrinone. Limitations exist within the available data, however, and questions remain about the generalizability of results across a broader spectrum of patients suffering from DCI. The development of a standardized protocol for milrinone use in DCI, specifically addressing areas requiring further clarification, is needed. Data generated from a standardized protocol may provide the impetus for a multicenter, randomized control trial. We review the current literature on milrinone for the treatment of DCI and propose a preliminary standardized protocol for further evaluation of both safety and efficacy of milrinone., Competing Interests: D.Y.C. has received grant funding from the National Institutes of Health (KL2TR002542 and K08NS112601), the American Heart Association and American Stroke Association (18POST34030369), the Andrew David Heitman Foundation, the Aneurysm and AVM Foundation, and the Brain Aneurysm Foundation. S.E.N. has received grant funding from the Brain Aneurysm Foundation as well as personal fees from Springer Nature. The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
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3. Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia.
- Author
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Abulhasan YB, Ortiz Jimenez J, Teitelbaum J, Simoneau G, and Angle MR
- Subjects
- Adult, Aged, Angioplasty, Brain Ischemia etiology, Cohort Studies, Female, Follow-Up Studies, Humans, Injections, Intra-Arterial, Magnetic Resonance Imaging, Male, Middle Aged, Neurosurgical Procedures methods, Tomography, X-Ray Computed, Treatment Outcome, Vasospasm, Intracranial complications, Brain Ischemia drug therapy, Milrinone therapeutic use, Vasodilator Agents therapeutic use, Vasospasm, Intracranial drug therapy
- Abstract
Objective: Intravenous (IV) milrinone is a promising option for the treatment of cerebral vasospasm with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, data remain limited on the efficacy of treating cases that are refractory to standard therapy with IV milrinone. The aim of this study was to determine predictors of refractory vasospasm/DCI despite treatment with IV milrinone, and to analyze the outcome of rescue therapy with intraarterial (IA) milrinone and/or mechanical angioplasty., Methods: The authors conducted a retrospective cohort study of all patients with aSAH admitted between 2010 and 2016 to the Montreal Neurological Institute and Hospital. Patients were stratified into 3 groups: no DCI, standard therapy, and rescue therapy. The primary outcome was frequency of DCI-related cerebral infarction identified on neuroimaging before hospital discharge. Secondary outcomes included functional outcome reported as modified Rankin Scale (mRS) score, and segment reversal of refractory vasospasm., Results: The cohort included 322 patients: 212 in the no DCI group, 89 in the standard therapy group, and 21 in the rescue therapy group. Approximately half (52%, 168/322) were admitted with poor-grade aSAH at treatment decision (World Federation of Neurosurgical Societies grade III-V). Among patients with DCI and imaging assessing severity of vasospasm, 62% (68/109) had moderate/severe radiological vasospasm on DCI presentation. Nineteen percent (21/110) of patients had refractory vasospasm/DCI and were treated with rescue therapy. Targeted rescue therapy with IA milrinone reversed 32% (29/91) of the refractory vasospastic vessels, and 76% (16/21) of those patients experienced significant improvement in their neurological status within 24 hours of initiating therapy. Moderate/severe radiological vasospasm independently predicted the need for rescue therapy (OR 27, 95% CI 8.01-112). Of patients with neuroimaging before discharge, 40% (112/277) had developed new cerebral infarcts, and only 21% (23/112) of these were vasospasm-related. Overall, 65% (204/314) of patients had a favorable functional outcome (mRS score 0-2) assessed at a median of 4 months (interquartile range 2-8 months) after aSAH, and there was no difference in functional outcome between the 3 groups (p = 0.512)., Conclusions: The aggressive use of milrinone was safe and effective based on this retrospective study cohort and is a promising therapy for the treatment of vasospasm/DCI after aSAH.
- Published
- 2020
- Full Text
- View/download PDF
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