Is there data on milrinone intra-arterial for cerebral angiography?

Comment by InpharmD Researcher

Available evidence on intra-arterial (IA) milrinone during cerebral angiography is limited and primarily supports its use as a therapeutic vasodilator during angiographic evaluation and endovascular treatment of cerebral vasospasm, particularly after aneurysmal subarachnoid hemorrhage. Across available studies, IA milrinone consistently produced angiographic improvement in vasospastic vessels, with generally favorable hemodynamic tolerance; however, the evidence is limited by small sample sizes, lack of control groups, and heterogeneous dosing regimens (Tables 1-7). Thus, IA milrinone may be used during cerebral angiography when treating symptomatic or refractory cerebral vasospasm, but there are insufficient data to support its routine use solely as an adjunct to cerebral angiography.

PubMed and Google Scholar were searched using combinations of “milrinone,” “intra-arterial,” “cerebral angiography,” “cerebral vasospasm,” and “subarachnoid hemorrhage.” Relevant clinical studies evaluating intra-arterial milrinone administration during cerebral angiography were reviewed.

Background

The 2023 American Heart Association/American Stroke Association (AHA/ASA) Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage notes limited, nonrandomized evidence for milrinone in the management of cerebral vasospasm/delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) and considers its role promising but requiring further investigation. Although the guideline cites a 2011 study evaluating intra-arterial milrinone for angiographic effects in patients with aSAH-associated vasospasm (Table 4), this evidence pertains to endovascular treatment of cerebral vasospasm rather than routine cerebral angiography. The guideline notes that intra-arterial vasodilators can be used to treat vasospasm involving proximal and distal cerebral vessels, but a range of agents, doses, and treatment durations have been used, with no high-quality randomized studies comparing these agents; systemic hypotension and increased intracranial pressure (ICP) are potential concerns. [1]

A 2021 narrative review evaluated the role of milrinone in the treatment of DCI following aSAH. This review systematically analyzed six studies, including single-center case series and retrospective cohorts, to assess intra-arterial (IA) and intravenous (IV) administration of milrinone. The studies highlighted milrinone’s dual mechanism—cerebral vasodilation mediated through phosphodiesterase III inhibition and potential anti-inflammatory effects—as promising for addressing the multifactorial etiology of DCI. Three studies focusing on IA administration and two studies exploring IV milrinone monotherapy demonstrated substantial angiographic improvement in vasospastic vessels with favorable safety profiles. Recommended milrinone dose ranges are: 0.75–1.25 mcg/kg/min for mild vasospasm, 1.0–1.5 mcg/kg/min for moderate vasospasm, and 1.0–2.0 mcg/kg/min for severe vasospasm. Nimodipine therapy should continue with milrinone, though its dose may be reduced or held during hemodynamic instability. Across all studies, adverse events, such as hypotension, were manageable with vasopressors, and less than 1% of patients experienced myocardial ischemia, highlighting the safety of high-dose milrinone therapy. These findings collectively suggest milrinone as a viable therapeutic option for DCI; however, randomized controlled trials are necessary to validate efficacy and standardize treatment protocols. [2]

Additional review articles have also described milrinone primarily in the context of treatment of cerebral vasospasm after aSAH, including its use during endovascular interventions rather than for routine cerebral angiography. A 2020 systematic review of 22 studies (641 patients) found substantial heterogeneity, with only 1 randomized controlled trial; 3 studies (95 patients) used intra-arterial milrinone, 9 used IV administration, and 6 used both routes. Among the studies using IA therapy, angiographic improvement in vasospasm was reported, including a 37%–53% increase in arterial diameter with IA milrinone in one prospective study, while another study reported a significant angiographic improvement (p<0.0001). One study comparing IA followed by IV milrinone with continuous IV therapy reported vasospasm reversal rates of 71% (59%–83%) versus 64% (58%–71%), respectively. Overall, the reviews describe IA milrinone as having promising angiographic effects and being used occasionally during endovascular treatment of symptomatic or refractory vasospasm, but emphasize that the evidence is limited and heterogeneous, with insufficient data to establish effects on patient-centered outcomes or identify an optimal IA regimen. [3], [4], [5]

Background References: [1] Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2023;54(7):e314-e370. doi:10.1161/STR.0000000000000436
[2] Bernier TD, Schontz MJ, Izzy S, et al. Treatment of Subarachnoid Hemorrhage-associated Delayed Cerebral Ischemia With Milrinone: A Review and Proposal. J Neurosurg Anesthesiol. 2021;33(3):195-202. doi:10.1097/ANA.0000000000000755
[3] Santos-Teles AG, Ramalho C, Ramos JGR, et al. Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review. Eficácia e segurança da milrinona no tratamento do vasoespasmo cerebral após hemorragia subaracnóidea: uma revisão sistemática. Rev Bras Ter Intensiva. 2020;32(4):592-602. doi:10.5935/0103-507X.20200097
[4] Daou BJ, Koduri S, Thompson BG, Chaudhary N, Pandey AS. Clinical and experimental aspects of aneurysmal subarachnoid hemorrhage. CNS Neurosci Ther. 2019;25(10):1096-1112. doi:10.1111/cns.13222
[5] Baumann A, Derelle AL, Mertes PM, Audibert G. Seeking new approaches: milrinone in the treatment of cerebral vasospasm. Neurocrit Care. 2012;16(3):351-353. doi:10.1007/s12028-012-9718-9
Literature Review

A search of the published medical literature revealed 7 studies investigating the researchable question:

Is there data on milrinone intra-arterial for cerebral angiography?

Level of evidence

C - Multiple studies with limitations or conflicting results  Read more→


Please see Tables 1-7 for your response.

Higher dose intra-arterial milrinone and intra-arterial combined milrinone-nimodipine infusion as a rescue therapy for refractory cerebral vasospasm
Design

Retrospective study

N= 25
Objective To assess the efficacy and safety of higher dose intra-arterial milrinone and combined milrinone-nimodipine infusion for refractory cerebral vasospasm (CV)
Study Groups Study subjects (N = 25)
Inclusion Criteria Subarachnoid hemorrhage (SAH) confirmed by CT, aneurysm confirmed by digital subtraction angiography (DSA), symptomatic CV
Exclusion Criteria Traumatic SAH, surgical clipping of aneurysms
Methods

Standard care included oral nimodipine (360 mg/day), anti-edema treatment with mannitol (0.25 g/kg/day) and dexamethasone (16 mg/day), analgesics (IV paracetamol and opioids), anti-epileptic treatment, and IV magnesium sulfate for hypomagnesemia. Fluids (30–40 ml/kg/day normal saline) and normovolemia were maintained, with a systolic blood pressure target of 140–180 mmHg. Norepinephrine was used if MAP fell below 90 mmHg. Blood glucose was kept between 80–150 mg/dL. After aneurysm repair, patients received dalteparin starting on day 2.

In case of CV (defined as a >40% reduction in vessel diameter), patients were treated with intra-arterial milrinone (6 mg/territory, total 18 mg). If CV was refractory, milrinone doses were increased (up to 24 mg total), or nimodipine was added. Angiograms guided treatment, and follow-up continued in intensive care for 14 days.
Duration

Trial: 2014 to 2017

Follow-up: 6-18 months post-SAH
Outcome Measures Diameter of vessels before and after infusion
Baseline Characteristics Characteristic Patients with CV Patients with Refractory CV
Sex (Female/Male) 18/7 4/2
Age 59.32 ± 9.82 57 ± 8.57
Aneurysm Localization Various locations * Various locations*
Mean Days from SAH to CV 7.92 ± 3.46 7.92 ± 3.46
Barthel Index Scores 85 (70-100) 90 (80-100)
Modified Rankin Scores 1 (0-3) 1 (0-2)
Average WFNS Scores 3 (1-4) 3 (2-4)
Average Glasgow Scores 13 (10-15) 13 (12-14)
Fisher Scores 3 (2-4) 3 (3-4)

*Various locations including middle cerebral artery bifurcation, internal carotid artery, anterior communicating artery, and posterior inferior cerebellar artery

CV: cerebral vasospasm; SAH: subarachnoid hemorrhage; WFNS: World Federation of Neuro Surgeon
Results Artery Diameter Before Infusion (CV) Diameter After Infusion (CV) Diameter Before Infusion (Refractory CV) Diameter After Infusion (Refractory CV)
Anterior Cerebral Artery 1.41 ± 0.43 2.19 ± 0.51 1.56 ± 0.49 2.42 ± 0.51
Middle Cerebral Artery 2.16 ± 0.49 2.95 ± 0.45 2.19 ± 0.50 2.98 ± 0.52
Vertebral Artery 0.96 ± 0.35 1.96 ± 0.61 0.96 ± 0.35 1.96 ± 0.61

Patient one experienced a CV on days 5, 6, and 8 of SAH despite standard protocol treatment. CV occurred in one territory. Milrinone doses administered were 8 mg on day 5 (right internal carotid artery [ICA]), 10 mg on day 6, and 14 mg on day 8.

Patient two experienced a CV from days 9–11 of SAH, with CV affecting two territories on days 9 and 10, and three territories on day 11. Milrinone doses given were 6 mg from each ICA (total 12 mg) on day 9, 10 mg from each ICA (total 20 mg) on day 10, and 10 mg from the right ICA, 8 mg from the left ICA, and 6 mg from the vertebral artery (total 24 mg) on day 11.

Patient three had CV in one territory four times: twice on day 8, and once each on days 9 and 10 of SAH. On day 8, 10 mg milrinone and 5 mg nimodipine were given from the right ICA, followed by 12 mg milrinone (total 22 mg) and 5 mg nimodipine. On day 9, 12 mg milrinone was given from the right ICA, and on day 10, 14 mg milrinone and 5 mg nimodipine were administered from the right ICA.

Patient four had CV in one territory five times on days 5, 7, 12, 13, and 17 of SAH. Milrinone doses were 8 mg on days 5 and 7, 10 mg on day 12, 14 mg on day 13, and 12 mg on day 17. Afterward, she experienced no further CV but developed hydrocephalus, leading to a third ventriculostomy. 

Patient five had CV on days 10–12 of SAH, affecting three territories on day 10, two on day 11, and one on day 12. Milrinone doses were 6 mg from each ICA and left vertebral artery (total 18 mg) on day 10, 10 mg from left ICA and 6 mg from left vertebral artery (total 16 mg) on day 11, and 12 mg milrinone with 5 mg nimodipine from left ICA on day 12.

Patient six had CV on different territories 11 times from days 3–6, 8, 9, and 11–13 of SAH, including twice on days 4 and 13. Milrinone doses were 6 mg from each ICA (total 12 mg) on day 3, 8 mg from each ICA (total 16 mg) on day 4, followed by 10 mg from each ICA (total 36 mg that day). On days 5, 6, 8, 9, 11, and 12, 10 mg milrinone was given from each ICA (total 20 mg). Nimodipine 5 mg was also given in some sessions. Milrinone was continuously administered IV on days 10–12. On day 13, 10 mg milrinone from the left ICA and 8 mg from the vertebral artery (total 18 mg) were given, followed by 12 mg from each ICA (total 42 mg). No further CV occurred, and the patient was discharged on day 23 with only motor dysfunction in the right lower extremity.
Adverse Events

Tachycardia in two patients; no significant changes in blood pressure or potassium levels
Study Author Conclusions

Higher doses of milrinone can effectively control refractory CV. High dose intra-arterial nimodipine and milrinone infusion can be used as rescue therapy for exceptional cases.
Critique

The strengths of the study include a systematic analysis of safety and efficacy, along with long-term follow-up. However, the limitations are that it is non-randomized, has a small sample size, lacks a control group, and does not include systematic cardiac output measurements.

 

Table 1 References:
[6] Duman E, Karako F, Pinar HU, Dogan R, Frat A, Yldrm 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):636-643. doi:10.1177/1591019917732288

 

Milrinone for the Treatment of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage
Design

Prospective study

N= 22
Objective To assess the efficacy and tolerance of milrinone in patients with cerebral vasospasm (CVS) secondary to aneurysmal subarachnoid hemorrhage (aSAH)
Study Groups All patients (n= 22)
Inclusion Criteria Patients suffering from aSAH with angiographically-proven CVS (arterial diameter reduction ≥40%)
Exclusion Criteria Not specified
Methods Intra-arterial milrinone was infused at 8 mg over 30 minutes into the cerebral territory affected by CVS, with repeat administration permitted for incomplete reversal and a maximum total dose of 24 mg, followed by continuous IV milrinone infusion through Day 14 after the initial hemorrhage. Mechanical angioplasty was performed in selected patients when CVS persisted after 2 IA milrinone infusions or when severe, early CVS was considered at high risk for recurrence. Angiographic response, hemodynamic tolerance, and long-term neurological outcomes were evaluated.
Duration February 2002 to April 2004
Outcome Measures Angiographic reversal of CVS, hemodynamic tolerance
Baseline Characteristics   All patients (n= 22)
Age, years 45 ± 11
Female 14
SAPS2 score 21 ± 12
World Federation of Neuro Surgeons (WFNS) score 2 ± 1
Fisher score 3 ± 1
Results   All patients (n= 22)
Vasospastic territories treated 72 territories
Selective IA milrinone infusions 34 infusions
Increase in arterial diameter, % 53 ± 37
Heart rate increase, bpm 75 ± 14 to 89 ± 21 (p=0.002)
CVS recurrence within 48 hours 5 (23%)
Mechanical angioplasty 8
Deaths in ICU 2 (9%)
Good neurological outcome, modified Rankin scale* 0.8 ± 1.0
Barthel index* 100 [95–100]
*Neurological outcomes were assessed 12–18 months after aSAH in 18 patients; 2 patients were lost to follow-up.
Adverse Events Moderate increase in heart rate; hypokalemia requiring supplementation in 5 patients; 2 patients receiving IV milrinone required norepinephrine for hypotension; no significant change in systemic arterial pressure following IA milrinone. 
Study Author Conclusions Milrinone is effective and safe for reversal of CVS after aSAH and should be tested in a large randomized trial.
Critique The study demonstrated the efficacy of milrinone in reversing CVS with good neurological outcomes. However, the lack of a control group limits the ability to attribute outcomes solely to milrinone. The small sample size and absence of systematic cardiac output measurements are additional limitations. 
Table 2 References:
[7] 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):893-898. doi:10.1161/STROKEAHA.107.492447

 

Milrinone for the Treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage: Report of Seven Cases
Design

Case series study

N= 7
Objective To examine the effects of intra-arterial and subsequent intravenous administration of milrinone on patients with symptomatic cerebral vasospasm
Study Groups All patients (n= 7)
Inclusion Criteria Patients aged 20-80 years with confirmed subarachnoid hemorrhage (SAH) via CT, surgically treated within 72 hours of SAH onset, aneurysm observed on angiogram, angiographic vasospasm suitable for symptoms, and informed consent obtained
Exclusion Criteria Not specified
Methods Milrinone was delivered intra-arterially via catheter at 0.25 mg/min with a total dose between 2.5 and 15 mg. Radiological measurement of middle cerebral artery (MCA) diameter and cerebral blood flow (CBF) was carried out before and after arterial infusion. Intravenous treatment followed at 0.50 or 0.75 mg/kg/min for up to 2 weeks from SAH onset.
Duration April 1999 to March 2000
Outcome Measures MCA diameter, cerebral blood flow, recurrence of symptomatic vasospasm, neurological symptoms, and hemodynamic effects
Baseline Characteristics   All patients (n= 7)
Age, years  60.6 ± 10.9
Female 4
Results   Before Milrinone After Milrinone
MCA diameter M1 segment, mm 1.29 ± 0.48 1.83 ± 0.46
MCA diameter M2 segment, mm 0.83 ± 0.24 1.49 ± 0.25
CBF ipsilateral MCA area, ml/100 g/min 32.5 ± 3.5 39.3 ± 3.3
Neurological symptoms improved gradually within a few hours after treatment in 7 of 12 treatments. Symptomatic vasospasm recurred in 3 of 7 patients (43%) despite subsequent IV milrinone; in each case, satisfactory redilation was achieved with the same IA milrinone treatment protocol. No significant changes in mean heart rate or blood pressure were observed. Mean systolic blood pressure decreased from 162 ± 20 to 155 ± 14 mm Hg, diastolic blood pressure from 83 ± 16 to 80 ± 21 mm Hg, and heart rate increased from 75 ± 17 to 90 ± 18 beats/min; these changes were not statistically significant.
Adverse Events No significant changes in mean heart rate or blood pressure were observed. No significant adverse events reported.
Study Author Conclusions Milrinone was effective and safe for the treatment of cerebral vasospasm after subarachnoid hemorrhage. Intra-arterial infusion with adjunctive intravenous infusion holds promise as a clinically advantageous treatment regimen.
Critique The study is limited by its small sample size and lack of a control group. The absence of a placebo or alternative treatment group makes it difficult to draw strong conclusions about the efficacy of milrinone compared to other treatments. Further studies with larger sample sizes and control groups are needed to confirm these findings. 
Table 3 References:
[8] 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):723-730. doi:10.1097/00006123-200104000-00004

Angiographic evaluation of the effect of intra-arterial milrinone therapy in patients with vasospasm from aneurysmal subarachnoid hemorrhage
Design

Retrospective study

N= 14
Objective To examine the effectiveness and safety of intra-arterial injection of milrinone for the treatment of vasospasm
Study Groups All patients (n= 14)
Inclusion Criteria Consecutive patients with angiographically confirmed vasospasm following aneurysmal subarachnoid hemorrhage between January 2006 and December 2007
Exclusion Criteria Not specified
Methods Patients received intra-arterial milrinone administered through a 4-French diagnostic angiographic catheter. Milrinone was mixed with normal saline to a concentration of 0.1 mg/ml and administered at a rate of 0.25 mg/min. The dose ranged from 2 to 15 mg, with a mean of 6.7 mg. Balloon angioplasty was performed in cases of severe vasospasm when milrinone alone was insufficient. 
Duration January 2006 to December 2007
Outcome Measures Angiographic improvement in vasospasm
Baseline Characteristics   All patients (n= 14)
Age, years 52.7 (31-68)
Female 11
Results   All patients (n= 14) p-value
Angiographic improvement in vasospasm Significant <0.0001
Angiographic improvement was 11.32% in the supraclinoid internal carotid artery (ICA), 37.5% in the M1/M2 segments of the middle cerebral artery (MCA), and 38.69% in the A1/A2 segments of the anterior cerebral artery (ACA) (p<0.0001). At discharge, 9 of 14 patients (64%) had a favorable outcome (mRS ≤3), while 1 patient died. Symptomatic vasospasm recurred in 4 of 14 patients (29%); only 1 required repeat IA milrinone, while the others were managed with triple H therapy.
Adverse Events Mild systemic hypotension during maintenance therapy with intravenous milrinone in three patients, which did not require changes in treatment.
Study Author Conclusions Intra-arterial milrinone was a safe and effective treatment for cerebral vasospasm following aneurysmal SAH, with significant angiographic improvement and favorable outcomes in two-thirds of patients.
Critique The study was limited by its retrospective nature, small sample size, and lack of a control group. The absence of long-term follow-up and reliance on MRS at discharge as a measure of efficacy are additional limitations. Further prospective clinical trials are needed to validate these findings.
Table 4 References:
[9] 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):123-128. doi:10.1007/s00234-010-0720-7

Milrinone as a Rescue Therapy for Symptomatic Refractory Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage
Design

Prospective study

N= 8
Objective To evaluate the safety and efficacy of intra-arterial Milrinone in patients with symptomatic refractory cerebral vasospasm
Study Groups All patients (n= 8)
Inclusion Criteria Older than 18 years; SAH diagnosis confirmed by CT; aneurysm identification by angiography; aneurysm exclusion; symptomatic cerebral vasospasm refractory to conventional therapy
Exclusion Criteria Not explicitly stated
Methods Patients with persistent symptoms despite standard therapy underwent four-vessel digital subtraction angiography. Refractory vasospasm was defined as persistence of angiographic vasospasm after intra-arterial papaverine (300 mg). Selective intra-arterial milrinone was then infused into the affected vessel at 0.25 mg/min until a satisfactory angiographic response was observed or a maximum dose of 15 mg was reached. Repeat IA milrinone was administered for recurrent vasospasm.
Duration January 2005 to March 2007
Outcome Measures Angiographic response, neurological and systemic complications, functional outcome at 3 months
Baseline Characteristics   All patients (n= 8)
Female 8 (100%)
Age, years 50 ± 10
Fisher grade III or IV 8 (100%)
WFNS score I–III 8 (100%)
Results   All patients (n= 8)
Significant angiographic improvement 8 (100%)
Recurrent vasospasm 3 (37.5%)
Neurologic or systemic complications 0 (0%)
Mean modified Rankin scale at 3 months 2 ± 1
Mean Barthel index at 3 months 83 ± 10
Adverse Events No neurological or systemic complications attributed to the intervention were observed.
Study Author Conclusions Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Critique The study is limited by its small sample size, lack of randomization, and absence of a control group. The angiographic response was measured qualitatively. Despite these limitations, it provides preliminary evidence supporting the use of intra-arterial Milrinone for refractory cerebral vasospasm.
Table 5 References:
[10] Romero CM, Morales D, Reccius A, et al. Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2009;11(2):165-171. doi:10.1007/s12028-008-9048-0

 

Intra-arterial milrinone may differentiate fulminant RCVS from vasculitis

Design

 Case report

Case presentation

 A 39-year-old woman taking a monoamine oxidase inhibitor presented with severe headache and visual field deficits; CT showed bilateral parietal infarcts and CT angiography demonstrated intracranial vessel narrowing, raising concern for vasculitis versus reversible cerebral vasoconstriction syndrome (RCVS). Despite methylprednisolone and nimodipine, her neurological status worsened. During urgent cerebral angiography, intra-arterial milrinone reversed the cerebral vasoconstriction and improved her neurological symptoms, supporting a diagnosis of RCVS. The authors suggested that IA milrinone may have diagnostic and therapeutic utility in RCVS but emphasized that prospective evaluation is needed. 

Study Author Conclusions

 Intra-arterial milrinone may be useful to differentiate vasculitis from RCVS and may serve as a treatment for RCVS, but requires prospective evaluation. 
Table 6 References:
[11] Laneuville M, Ding J, Shamy M, Lum C, Dowlatshahi D. Intra-arterial milrinone may differentiate fulminant RCVS from vasculitis. Neurology. 2017;89(10):1093-1094. doi:10.1212/WNL.0000000000004337

Endovascular Therapy for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: The RESCUE-CV Randomized Trial
Design

Multicenter, prospective, randomized controlled clinical trial

N= 306
Objective To evaluate whether early continuous milrinone-based endovascular therapy improves outcomes in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage
Study Groups

Control Group (Standardized Medical Management Group)

Experimental Group (Continuous Milrinone-Based Endovascular Therapy Plus Standardized Medical Management)
Inclusion Criteria Aged 18 to 80 years; SAH confirmed by cranial CT, with an intracranial aneurysm identified by CTA, MRA, or DSA; prior treatment of the aneurysm by endovascular intervention or surgical clipping; evidence suggestive of CVS within 14 days after onset
Exclusion Criteria Hunt-Hess grade 5 with critical illness; contraindications to milrinone; perioperative procedure-related complications; irreversible cerebral infarction; poor blood pressure control; non-aneurysmal SAH; severe neurological disorders; severe systemic disease; pregnant or breastfeeding women; current participation in another interventional clinical study
Methods Participants in the experimental group will receive intra-arterial milrinone during endovascular treatment, with mechanical angioplasty when clinically indicated, followed by continuous intravenous milrinone infusion for 72 hours. The control group will receive standardized medical management including nimodipine, fluid management, and blood pressure augmentation
Duration

Study Start: June 2026

Primary Completion: December 2028

Study Completion: December 2029
Outcome Measures

Primary: Poor neurological outcome within 90 days (mRS score of 3-6)

Secondary: Delayed cerebral ischemia, vasospasm resolution rate, severity of clinical condition, cognitive function, health-related quality of life, total hospitalization cost, length of hospital and ICU stay
Baseline Characteristics Not available
Results Ongoing trial, No results are currently available
Adverse Events Not available. 
Study Author Conclusions The study aims to provide high-quality evidence for early continuous milrinone-based endovascular therapy as a treatment strategy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage
Critique The study is well-designed as a multicenter, prospective, randomized controlled trial, which is a strength. However, the study is not yet recruiting and has no available efficacy or safety results; therefore, its findings cannot currently inform clinical effectiveness or safety.
Table 7 References:
[12] ClinicalTrials.gov. Endovascular Therapy for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: The RESCUE-CV Randomized Trial. ClinicalTrials.gov identifier NCT07643922. Updated June 12, 2026. Accessed August 11, 2026. https://clinicaltrials.gov/study/NCT07643922