Romero et al.(11 Romero CM, Morales D, Reccius A, Mena F, Prieto J, Bustos P, et al. Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2009;11(2):165-71.)
|
Observational, uncontrolled, prospective |
8 |
50 ± 10 |
1 (12.5) |
3 - 4 |
NA |
Aneurysmal |
Pcom: 3 Acom: 2 MCA: 2 ICA: 1 |
IA |
Infusion 0.25mg/minute Maximal 15mg |
TCD |
Angiography |
All patients had significant angiographic response (> 20% decrease in stenosis) after milrinone |
Fraticelli et al.(55 Fraticelli AT, Cholley BP, Losser MR, Saint Maurice JP, Payen D. Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2008;39(3):893-8.)
|
Observational, uncontrolled, prospective |
22 |
45 ± 11 |
15 (68.1) |
2 - 4 |
NA |
Aneurysmal |
Pcom: MCA: 5 BA: 2 Acom: 7 ACA: 2 ICA: 1 Not available: 1 |
IA/IV |
Infusion 8mg IA and 0.5-1.5mcg/kg/minute IV |
TCD |
Angiography |
Intra-arterial milrinone resulted in a 37% - 53% increase in arterial diameter |
Shankar et al.(1414 Shankar JJ, dos Santos MP, Deus-Silva L, Lum C. Angiographic evaluation of the effect of intra-arterial milrinone therapy in patients with vasospasm from aneurysmal subarachnoid hemorrhage. Neuroradiology. 2011;53(2):123-8.)
|
Observational, uncontrolled, retrospective |
14 |
52.7 (31 - 68) |
11 (78.5) |
3 - 4 |
1 - 5 |
Aneurysmal |
Acom: 6 MCA: 3 ICA: 2 Pcom: 3 |
IA |
Maximum 1.13mg/kg/day |
TCD |
Angiography |
2/3 of the treated patients had favorable neurologic outcome |
Arakawa et al.(1616 Arakawa Y, Kikuta K, Hojo M, Goto Y, Ishii A, Yamagata S. Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases. Neurosurgery. 2001;48(4):723-8; discussion 728-30.)
|
Observational, uncontrolled, prospective |
7 |
60.6 ± 10.9 |
4 (57.1) |
2 - 3 |
NA |
Aneurysmal |
Acom: 5 ICA/Pcom/ MCA: 1 ICA: 1 |
IA/IV |
Infusion 4 - 15mg IA and 0.5 - 0.75mg/kg/minute IV |
Angiography or TCD |
Angiography and CT |
Mean MCA diameter increased from 1.29 ± 0.48mm to 1.83 ± 0.46mm in the M1 segment and from 0.83 ± 0.24mm to 1.49 ± 0.25mm in the M2 segment |
Alturki et al.(2222 Alturki AY, Alamri AS, Badawy MM, Lo BW. Basilar artery vasospasm after pretuncal non-aneurysmal subarachnoid hemorrhage responding to milrinone. Neurosciences (Riyadh). 2017;22(2):134-7.)
|
Observational, uncontrolled, prospective |
1 |
42 |
1(100) |
2 |
2 |
Pretuncal |
Not aneurysmal |
IV |
Bolus 5mg and infusion 0.5mcg/kg/minute After 4 days: infusion: 0.25mcg/kg/minute for 24 hours |
Angiography |
Angiography |
The patient was discharged in stable condition without neurological deficit |
Anand et al.(2323 Anand S, Goel G, Gupta V. Continuous intra-arterial dilatation with nimodipine and milrinone for refractory cerebral vasospasm. J Neurosurg Anesthesiol. 2014;26(1):92-3.)
|
Observational, uncontrolled, prospective. |
1 |
45 |
1 (100) |
3 |
NA |
Aneurysmal |
Acom |
IA/IV |
3 sessions of 10mg IA followed by 1mcg/kg/minute IV |
Angiography |
Angiography |
The patient recovered fully without neurological deficits |
Zeiler et al.(2424 Zeiler FA, Silvaggio J. Early angiographic resolution of cerebral vasospasm with high dose intravenous milrinone therapy. Case Rep Crit Care. 2015;2015:164597.)
|
Observational, uncontrolled, prospective |
1 |
66 |
1 (100) |
4 |
4 |
Aneurysmal |
LACA |
IV |
Infusion 5mg followed by 0.75mcg/kg/minute |
Angiography |
Angiography |
Within minutes of the infusion, the patient resolved the neurologic deficits |
Wu et al.(2525 Wu EM, El Ahmadieh TY, Kafka B, Davies MT, Aoun SG, White JA. Milrinone-associated cardiomyopathy and arrhythmia in cerebral vasospasm. World Neurosurg. 2018;114:252-6.)
|
Observational, uncontrolled, prospective |
1 |
40 |
1 (100) |
4 |
3 |
Aneurysmal |
SCA and Pcom |
IV |
0.75mcg/kg/minute |
Angiography |
CT |
Patient developed cardiomyopathy and arrhythmia |
Lasry et al.(2626 Lasry O, Marcoux J. The use of intravenous milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage. Springerplus. 2014;3:633.)
|
Observational, uncontrolled, prospective |
2 |
64 |
1 (50) |
3 |
2 - 3 |
Traumatic |
NA |
IV |
Bolus 0.1mg/kg and infusion 0.75mcg/kg/minute |
NA |
Angiography and CT |
Improvement of neurologic deficits in both treated patients |
Genonceaux et al.(2727 Genonceaux S, Cosnard G, Van De Wyngaert F, Hantson P. Early ischemic lesions following subarachnoid hemorrhage: common cold remedy as precipitating factor? Acta Neurol Belg. 2011;111(1):59-61.)
|
Observational, uncontrolled, prospective |
1 |
46 |
1 (100) |
3 |
3 |
Aneurysmal |
Pcom |
IA/IV |
Infusion 10mg IA and 0.5mcg/kg/minute IV |
TCD |
TCD |
Consciousness improved after the administration of milrinone |
Lannes et al.(2828 Lannes M, Teitelbaum J, del Pilar Cortés M, Cardoso M, Angle M. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol. Neurocrit Care. 2012;16(3):354-62.)
|
Observational, uncontrolled, prospective |
88 |
53.4 (34 - 78) |
69 (78.4) |
1 - 4 |
1 - 5 |
Aneurysmal |
ACA: 10 Acom: 32 BA: 3 ICA: 2 MCA: 14 Pcom: 22 Other arteries: 5 |
IV |
Bolus 0.1 - 0.2mg/kg. Infusion 0.75 - 1.25mcg/kg/minute |
Angiography or TCD |
Angiography or TCD |
Overall, 48.9% of the patients were able to return to all their previous activities, and 75% had a good outcome. No significant side effects and no medical complications associated with the protocol were observed |
Sherif et al.(2929 Sherif C, Wambacher B, Loyoddin M, Karaic R, Krafft P, Valentin A, et al. Repeated combined endovascular therapy with milrinone and nimodipine for the treatment of severe vasospasm: preliminary results. Acta Neurochir Suppl. 2015;120:203-7.)
|
Observational, uncontrolled, prospective |
16 |
NA |
NA |
2 - 4 |
1 - 4 |
Aneurysmal |
ACA: 6 ICA: 6 MCA: 2 BA: 1 PICA: 1 |
EV |
4 - 8mg |
TCD |
TCD |
There was angiographic improvement of vessel diameters in 87.5% of patients and an improvement of neurological deficits in 68.5% of patients |
Hejčl et al.(3030 Hejčl A, Cihláč F, Smolka V, Vachata P, Bartoš R, Procházka J, et al. Chemical angioplasty with spasmolytics for vasospasm after subarachnoid hemorrhage. Acta Neurochir (Wien). 2017;159(4):713-20.)
|
Observational, uncontrolled, retrospective |
34 |
51 (23 - 73) |
27 (79.4) |
NA |
NA |
Aneurysmal |
ACA:14 MCA: 13 ICA: 6 BA: 1 |
IV |
Infusion 8mg continued with 0.5 - 1.5mcg/kg/minute for a maximum of 2 weeks |
TCD |
Angiography |
Angiographic results demonstrated decrease in vasospasm in 92% of the patients |
Koyanagi et al.(3131 Koyanagi M, Fukuda H, Lo B, Uezato M, Kurosaki Y, Sadamasa N, et al. Effect of intrathecal milrinone injection via lumbar catheter on delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Neurosurgery. 2018;128(3):717-22.)
|
Observational, controlled, retrospective |
142 |
62 (51 - 72) |
104 (73.2) |
4 |
5 |
Aneurysmal |
ACA: 55 ICA: 39 MCA: 38 PC: 10 |
IT |
0.87mg |
Angiography |
Angiography |
There were fewer DCI events (4% versus 14%) in patients treated with intrathecal milrinone compared with those treated without it |
Schmidt et al.(3232 Schmidt U, Bittner E, Pivi S, Marota JJ. Hemodynamic management and outcome of patients treated for cerebral vasospasm with intraarterial nicardipine and/or milrinone. Anesth Analg. 2010;110(3):895-902.)
|
Observational, uncontrolled, retrospective |
73 |
52 (33 - 82) |
50 (68.4) |
NA |
NA |
Aneurysmal |
NA |
IA |
NA |
TCD |
Angiography |
In 91% of cases, there was an improvement in vasospasm. Thirty-day mortality was 11% |
Duman et al.(3333 Duman E, Karakoc F, Pinar HU, Dogan R, Fırat A, Yıldırım E. Higher dose intra-arterial milrinone and intra-arterial combined milrinone-nimodipine infusion as a rescue therapy for refractory cerebral vasospasm. Interv Neuroradiol. 2017;23(6):636-43.)
|
Observational, uncontrolled, retrospective |
25 |
59.3 ± 9.8 |
18 (72) |
1 - 4 |
NA |
Aneurysmal |
MCA: 32% ICA: 24% ACA: 40% PICA: 4% |
IA/IV |
Maximal 10 - 16mg milrinone |
Angiography |
Angiography |
In refractory vasospasm, high doses of milrinone led to an improvement in vasospasm |
Arakawa et al.(3434 Arakawa Y, Kikuta K, Hojo M, Goto Y, Yamagata S, Nozaki K, et al. Milrinone reduces cerebral vasospasm after subarachnoid hemorrhage of WFNS grade IV or V. Neurol Med Chir (Tokyo). 2004;44(8):393-400; discussion 401.)
|
Observational, uncontrolled, retrospective |
12 |
64.9 ± 13.8 |
7 (58.3) |
3 - 4 |
NA |
Aneurysmal |
BA: 2 Acom: 4 MCA: 2 VA: 1 ICA: 1 ICA/Pcom: 1 BA/SCA: 1 |
C |
Infusion 3.6mg/mL 30mL/hour for 2 weeks |
NA |
Angiography |
Angiographical vasospasm resolved in 9 of the 11 patients who received milrinone administration |
Sadamasa et al.(3535 Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Milrinone via lumbar subarachnoid catheter for vasospasm after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2014;21(3):470-5.)
|
Observational, uncontrolled, retrospective |
425 |
NA |
NA |
NA |
NA |
Aneurysmal |
AC: 492 PC: 78 |
IT |
0.87mg |
NA |
NA |
Delayed ischemic neurological deficit was observed in 16.0% of the patients, DCI was observed in 7.1%, and the overall mortality was 7.2% after milrinone therapy |
Santos-Teles et al.(3636 Santos-Teles AG, Passos RH, Panerai RB, Ramalho C, Farias S, Rosa JG, et al. Intravenous administration of milrinone, as an alternative approach to treat vasospasm in subarachnoid haemorrhage: a case report of transcranial Doppler monitoring. Clin Case Rep. 2019;7(4):648-52.)
|
Observational, uncontrolled, prospective |
1 |
63 |
1 (100) |
4 |
5 |
Aneurysmal |
NA |
IV |
Infusion 0.75mcg/kg/minute IV |
TCD |
TCD |
TCD performed after milrinone administration showed a reduction in cerebral blood flow compatible with the absence of vasospasm |
Crespy et al.(3737 Crespy T, Heintzelmann M, Chiron C, Vinclair M, Tahon F, Francony G, et al. Which protocol for milrinone to treat cerebral vasospasm associated with subarachnoid hemorrhage? J Neurosurg Anesthesiol. 2018;31(3):323-9.)
|
Observational, uncontrolled, prospective |
101 |
50.5 (42 - 59) |
33 (32.6) |
3 - 4 |
NA |
Aneurysmal |
Acom: 38 MCA: 28 Pcom: 14 ICA: 9 Other: 12 |
IV/IA |
Infusion 8mg IA following by 1mcg/kg/minute IV or only 1mcg/kg/minute IV |
TCD |
Angiography or CT |
The reversion rate was 71% the IA + IV protocol versus 64% in the IV protocol |
Katyal et al.(3838 Katyal N, George P, Nattanamai P, Raber LN, Beary JM, Newey CR. Improvement in sonographic vasospasm following intravenous milrinone in a subarachnoid hemorrhage patient with normal cardiac function. Cureus. 2018;10(7):e2916.)
|
Observational, uncontrolled, prospective |
1 |
31 |
0 (0) |
4 |
NA |
Not aneurysmal or traumatic |
NA |
IV |
Bolus 0.1mg/kg IV and 0.5 - 0.75mcg/kg/minute IV |
TCD |
TCD |
TCD performed at 6.5 hours after the initial TCD showed a reduction in mean flow velocities in all vascular territories and cardiac output remained unchanged |
Soliman et al.(3939 Soliman R, Zohry G. [Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study]. Rev Bras Anestesiol. 2019;69(1):64-71. Portuguese.)
|
Interventional, randomized, prospective, controlled |
90 |
50.86 ± 9.3 |
41 (45.5) |
2 - 3 |
NA |
Aneurysmal |
MCA: 25 ACA: 11 Acom: 32 Pcom: 22 |
IV |
Infusion 0.5mcg/kg/minute IV |
TCD |
Angiography or CT |
The mean cerebral blood flow velocity decreased in the patients of the magnesium group and increased in the patients of the milrinone group. When compared with milrinone magnesium decreased the incidence of cerebral vasospasm |