Table 2 Summary of studies that have utilized intraventricular or cisternal nicardipine for the treatment of aSAH-associated vasospasm
Author | Study type | Vasopasm diagnosis | IVTN treatment | Patients (control) | Aneurysm | HH grade | Fisher grade | Aneurysm treatment | Results | Patient outcomes | Complications |
|---|---|---|---|---|---|---|---|---|---|---|---|
Acute treatment for vasopasm | |||||||||||
Ko 2016 [16] | Retrospective case series Study of hemodynamic changes during intraventricular nicardipine treatment (IVTN) in refractory vasospasm | Multimodality monitoring, brain oxygen tension, CBF, brain metabolism | 4 mg, q8 nicardipine solution Clamp EVD for 1 h Mean 4.9 doses/patient | 11 (0) Age mean: 49 8 female 3 male | NA | IV: 5 V: 6 | 3: 7 pt. 4: 4 pt | NA | *Mean ICP increased slightly (2.5 ± 0.9 mmHg), peaking at 20 m *ICP decreased 20–30 m after injection (3.7 ± 1.8 mmHg) *MAP, PBO2, CBF, autoregulation indices did not change significantly | 3 month follow up mRS 5: 8 patients mRS 6: 3 patients | Pneumonia (2) Seizures (2) Sepsis (2) Globala cerebral edema (11) Hydrocephalus (8) MI (2) |
Lu 2012 [15] | Retrospective case-control Monitored IVTN effects with TCD | TCDs | 4 mg Median 7 doses/patient (range 1–17) | 14 (14)** Age mean: 45 12 female 2 male | ACOM: 3 PICA: 2 PCOM: 2 MCA: 2 Pericallosal: 1 Vertebral: 1 VB: 1 ICA: 1 ACA: 1 | NA | 3: 3 pt. 4: 11 pt | Coil: 8 Clip: 5 Stent: 1 | *Mean flow velocity decreased after IVTN (R MCA: 120.2—> 82.0 cm/s, L MCA: 101.6—> 72.8 cm/s) *No significant difference in clinical outcomes | No significant difference between control and treatment group at 30 and 90 days | No bleeding or infection incidents. |
Webb 2010 [24] | Retrospective case series TCD measurement of changes post-IVTN | TCDs | 4 mg q8–12 Clamp EVD for 30 m Mean 6.7 doses/patient | 64 (0) Age mean: 52 | NA | I, II: 13 III: 30 IV, V: 21 | 2: 6 pt. 3: 45 pt. 4: 13 pt | Coil: 35 Clip: 29 | *IVTN reduced mean flow velocity by 26.3 cm/s in MCA and 7.4 cm/s in ACA, maintained over 24 h with continued administration *No change in ICP | Not described. | Ventricular-related infection: 4 clinically proven, 7 clinically possible |
Ehtisham 2009 [23] | Retrospective case series Vasospasm refractory to standard medical and endovascular treatment. | TCDs | 4 mg q12; stopped once MCA velocity < 120 cm/s Clamp EVD for 30 m | 6 (0) Age mean: 45 5 female 1 male | PCA: 2 ACA: 1 PICA: 1 VB: 1 Pericallosal: 1 | II: 1 III: 2 IV: 2 V: 1 | 3: 2 pt. 4: 4 pt | Coil: 3 Clip: 3 | *IVTN reduced MCA flow velocity by 43.1 ± 31.0 cm/s | Not described. | No major infection or reverse reaction. |
Goodson 2008 [25] | Retrospective case series IVTN used in refractory vasospasm | Symptomatic | 4 mg q12 Clamp EVD for 1 h Length of treatment 9.5 days (5–17) | 8 (0) Age mean: 51 7 female 1 male | ACA: 3 ACOM: 3 MCA: 1 PICA: 1 | I: 4 II: 2 III: 2 | 4: 8 pt | Coil: 5 Clip: 3 | *IVTN well-tolerated with minimal side effects | *7 moderate to good outcomes *1 patient died in ICU *Median modified rankin score: 2 (2–6) | 1 had nausea and headache |
PROPHYLACTIC TREAMENT FOR VASOSPASM | |||||||||||
Barth 2009 [26] | Prospective trial Intraventricular nicardipine prolonged release implants (NPRI) | Angiogram or CT angiogram | 6 or 10 pellets, 4 mg/pellet | 31 (16)** Age mean: 52 20 female 11 male | ACA: 15 PCOM: 5 MCA: 4 VB: 2 PICA: 2 Pericallosal: 2 ICA: 1 | I: 6 II: 11 III: 7 IV: 7 | NA | Clip: 17 Coil: 14 | *NRPI had larger mean diameter on DSA (90 ± 24% vs 80 ± 30% control) *NPRI group had less moderate/severe vasospasm (41% vs 73% control) *Effect not seen in coil group *No difference in dose | Not described. | No different from control group |
Suzuki 2001 [22] | Prospective trial Post operative intrathecal nicardipine | Symptomatic angiogram | 4 mg, q12 on post-op days 3–14 (via cisternal drain) | 177 (0) Age mean: 59 121 female 56 male | ICA: 66 ACOM: 58 MCA: 43 ACA: 6 VB: 4 | I: 11 II: 112 III: 35 IV: 16 V: 2 | NA | Clipped: 177 | *20 (11.3%) with angiographic vasospasm *10 (5.7%) with symptomatic vasospasm *Low rates compared to literature (aVS 19–97%, sVS 5–90%) | mRS 2–3: 89.2% at 6 months | 11 (6.2%) meningitis |
Shibuya 1994 [21] | Prospective trial Post operative intrathecal nicardipine | Symptomatic angiogram | 2 mg, q8 for 10–14 days (via cisternal drain) | 50 (91)** Age mean: 54 | ACA: 23 ICA: 13 MCA: 14 VB: 0 | I: 0 II: 15 III: 25 IV: 10 | NA | Clipped: 50 | *Symptomatic vasospasm decreased by 26% *Angiographic vasospasm decreased by 20% *Neither are statistically significant *Increased ‘good clinical outcome’ at 1 month post-bleed by 15% | Not described. | 2 (4%) meningitis 4 (8%) hydrocephalus requiring shunts |