{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:04:46Z","timestamp":1784307886622,"version":"3.55.0"},"reference-count":12,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cerebral vasospasm is a major complication of aneurysmal subarachnoid hemorrhage and a key contributor to delayed cerebral ischemia, which remains a leading cause of morbidity despite standard therapy with nimodipine and induced hypertension. Up to 30% of patients develop refractory delayed cerebral ischemia, highlighting the need for alternative therapeutic strategies. Milrinone has emerged as a promising option due to its combined vasodilatory and inotropic properties. We report the case of a 42\u2010year\u2010old man who developed progressive neurological deterioration following aneurysmal subarachnoid hemorrhage secondary to rupture of an anterior cerebral artery aneurysm. Despite definitive microsurgical clipping and optimal standard management, the patient developed refractory delayed cerebral ischemia with severe vasospasm. A stepwise, physiology\u2010guided treatment strategy was implemented, including high\u2010dose intravenous milrinone infusion, intra\u2010arterial milrinone administration, and rescue balloon angioplasty. This approach resulted in significant angiographic improvement, progressive neurological recovery, and successful ventilatory weaning. This case highlights the value of a multimodal, escalation\u2010based strategy for the management of refractory delayed cerebral ischemia, supporting the use of milrinone as a potential first\u2010line rescue therapy and reserving balloon angioplasty for non\u2010responders. It reinforces the concept of delayed cerebral ischemia as a multifactorial process and underscores the critical role of intensive neuromonitoring in enabling safe and effective therapeutic escalation.<\/jats:p>","DOI":"10.1002\/ccr3.72786","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:51:32Z","timestamp":1779684692000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Vasospasm: Dual Milrinone and Balloon Angioplasty in Refractory Delayed Cerebral Ischemia Post\u2010Subarachnoid Hemorrhage"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8397-3901","authenticated-orcid":false,"given":"Paul","family":"Cardozo Gil","sequence":"first","affiliation":[{"name":"Cl\u00ednica de las Am\u00e9ricas, Hospital Obrero Nro. 3\u2014Caja Nacional de Salud  Santa Cruz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9459-6215","authenticated-orcid":false,"given":"Willy","family":"Pozo Soto","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de las Am\u00e9ricas, Hospital Obrero Nro. 3\u2014Caja Nacional de Salud  Santa Cruz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5050-6861","authenticated-orcid":false,"given":"Alejandro","family":"Sengoku Cadima","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de las Am\u00e9ricas, Hospital Obrero Nro. 3\u2014Caja Nacional de Salud  Santa Cruz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3537-5132","authenticated-orcid":false,"given":"Pablo","family":"Flores","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de las Am\u00e9ricas, Hospital Obrero Nro. 3\u2014Caja Nacional de Salud  Santa Cruz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1308-3865","authenticated-orcid":false,"given":"Jorge","family":"Botello Marin","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de las Am\u00e9ricas, Hospital Obrero Nro. 3\u2014Caja Nacional de Salud  Santa Cruz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7713-5638","authenticated-orcid":false,"given":"Gustavo","family":"Averanga","sequence":"additional","affiliation":[{"name":"Hospital Italiano de Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5914-4802","authenticated-orcid":false,"given":"Richy","family":"Hurtado Monta\u00f1o","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de las Am\u00e9ricas, Hospital Obrero Nro. 3\u2014Caja Nacional de Salud  Santa Cruz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9545-9186","authenticated-orcid":false,"given":"Nelson","family":"Montalvo Flores","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de las Am\u00e9ricas, Hospital Obrero Nro. 3\u2014Caja Nacional de Salud  Santa Cruz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.68.3.337"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ANA.0000000000000755"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.492447"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000276"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0247942"},{"key":"e_1_2_12_7_1","first-page":"1","volume-title":"xPharm: The Comprehensive Pharmacology Reference","author":"Ayres J. 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