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Systematic Review of Intrathecal Nicardipine for the Treatment of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

  • Shaheryar HafeezEmail author
  • Ramesh Grandhi
Review Article
  • 181 Downloads

Abstract

Intrathecal nicardipine has been shown to have some efficacy for the treatment of symptomatic cerebral vasospasm in aneurysmal subarachnoid hemorrhage (aSAH). We performed a PRISMA-based systematic review of intrathecal nicardipine for the treatment of cerebral vasospasm in aneurysmal subarachnoid hemorrhage. A total of 825 articles were reviewed. After duplicates were removed and the search criteria was applied, 9 articles remained that were eligible for inclusion and analysis. 377 patients received a total of 6,596 injections of intrathecal nicardipine for aSAH-related cerebral vasospasm. The cumulative ventriculostomy-associated infection risk was 6%. Intrathecal nicardipine injections for aSAH-related cerebral vasospasm appears efficacious and safe. Administration of 4 mg of nicardipine every 12 hours was the most commonly reported dosing regimen. Intrathecal nicardipine decreases mean flow velocities on transcranial Doppler and reduces angiographic and clinical vasospasm. The infection risk appears to be in-line with studies in which rates of EVD-related infections have been reported.

Notes

Authors’ Contributions

SH and RG contributed equally to the design of the study. SH performed the preliminary data analysis with confirmation by RG. SH and RG equally contributed to the analysis of the results and writing of the manuscript.

Source of Support

The authors received no support for this contribution.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

12028_2018_659_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)

References

  1. 1.
    Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37.CrossRefGoogle Scholar
  2. 2.
    Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke. 2010;41(8):e519–36.CrossRefGoogle Scholar
  3. 3.
    Velat GJ, Kimball MM, Mocco J, Hoh BL. Vasospasm after aneurysmal subarachnoid hemorrhage: review of randomized controlled trials and meta-analyses in the literature. World Neurosurg. 2011;76(5):446–54.CrossRefGoogle Scholar
  4. 4.
    Petruk KC, West M, Mohr G, Weir BK, Benoit BG, Gentili F, et al. Nimodipine treatment in poor-grade aneurysm patients: results of a multicenter double-blind placebo-controlled trial. J Neurosurg. 1988;68(4):505–17.CrossRefGoogle Scholar
  5. 5.
    Fujiwara K, Mikawa S, Ebina T. Continuous intrathecal administration of nicardipine using a portable infusion pump system for management of vasospasm after subarachnoid hemorrhage. No shinkei geka Neurol Surg. 2001;29(1):23–30.Google Scholar
  6. 6.
    Haley EC Jr, Kassell NF, Torner JC. Participants: a randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage: a report of the Cooperative Aneurysm Study. J Neurosurg. 1993;78(4):537–47.CrossRefGoogle Scholar
  7. 7.
    Ko S-B, Choi HA, Helbok R, Kurtz P, Schmidt JM, Badjatia N, et al. Acute effects of intraventricular nicardipine on cerebral hemodynamics: a preliminary finding. Clin Neurol Neurosurg. 2016;144:48–52.CrossRefGoogle Scholar
  8. 8.
    Lu N, Jackson D, Luke S, Festic E, Hanel RA, Freeman WD. Intraventricular nicardipine for aneurysmal subarachnoid hemorrhage related vasospasm: assessment of 90 days outcome. Neurocrit Care. 2012;16(3):368–75.CrossRefGoogle Scholar
  9. 9.
    Ehtisham A, Taylor S, Bayless L, Samuels OB, Klein MW, Janzen JM. Use of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm. South Med J. 2009;102(2):150–3.CrossRefGoogle Scholar
  10. 10.
    Goodson K, Lapointe M, Monroe T, Chalela JA. Intraventricular nicardipine for refractory cerebral vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2008;8(2):247–52.CrossRefGoogle Scholar
  11. 11.
    Webb A, Kolenda J, Martin K, Wright W, Samuels O. The effect of intraventricular administration of nicardipine on mean cerebral blood flow velocity measured by transcranial Doppler in the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2010;12(2):159–64.CrossRefGoogle Scholar
  12. 12.
    Suzuki M, Doi M, Otawara Y, Ogasawara K, Ogawa A. Intrathecal administration of nicardipine hydrochloride to prevent vasospasm in patients with subarachnoid hemorrhage. Neurosurg Rev. 2001;24(4–6):180–4.CrossRefGoogle Scholar
  13. 13.
    Shibuya M, Suzuki Y, Enomoto H, Okada T, Ogura K, Sugita K. Effects of prophylactic intrathecal administrations of nicardipine on vasospasm in patients with severe aneurysmal subarachnoid haemorrhage. Acta Neurochir. 1994;131(1–2):19–25.CrossRefGoogle Scholar
  14. 14.
    Toyota A, Nishizawa Y. Cerebral vasospasm after subarachnoid hemorrhage, and inhibitory effect of nicardipine investigated by means of transcranial Doppler ultrasonography. No shinkei geka Neurol Surg. 1991;19(12):1143–50.Google Scholar
  15. 15.
    Yamamoto M, Ohta T, Toda N. Mechanisms of relaxant action of nicardipine, a new Ca ++-antagonist, on isolated dog cerebral and mesenteric arteries. Stroke. 1983;14(2):270–5.CrossRefGoogle Scholar
  16. 16.
    Pasqualin A, Vollmer DG, Marron JA, Tsukahara T, Kassell NF, Torner JC. The effect of nicardipine on vasospasm in rabbit basilar artery after subarachnoid hemorrhage. Neurosurgery. 1991;29(2):183–8.CrossRefGoogle Scholar
  17. 17.
    Williams TA, Leslie GD, Dobb GJ, Roberts B, van Heerden PV. Decrease in proven ventriculitis by reducing the frequency of cerebrospinal fluid sampling from extraventricular drains. J Neurosurg. 2011;115(5):1040–6.CrossRefGoogle Scholar
  18. 18.
    Inoue T, Shimizu H, Fujimura M, Sato K, Endo H, Niizuma K, et al. Risk factors for meningitis after craniotomy in patients with subarachnoid hemorrhage due to anterior circulation aneurysms rupture. Clin Neurol Neurosurg. 2015;139:302–6.CrossRefGoogle Scholar
  19. 19.
    Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51(1):170–82.CrossRefGoogle Scholar
  20. 20.
    Hanley DF, Lane K, McBee N, Ziai W, Tuhrim S, Lees KR, et al. Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. The Lancet. 2017;389(10069):603–11.CrossRefGoogle Scholar
  21. 21.
    Edge therapeutics provides update following interim analysis of phase 3 NEWTON 2 study of EG-1962 in aneurysmal subarachnoid hemorrhage. GlobeNewswire. 28 March 2018.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Neurocritical Care, Department of NeurosurgeryUT Health San AntonioSan AntonioUSA
  2. 2.Department of NeurosurgeryUniversity of UtahSalt Lake CityUSA

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