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Table 2 Summary of studies that have utilized intraventricular or cisternal nicardipine for the treatment of aSAH-associated vasospasm

From: Protective effect of unilateral vasospasm in the setting of HHH-associated posterior reversible encephalopathy syndrome: case report, review of the literature, and treatment considerations

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
  1. **Historical controls; VS vasospasm; IVTN intraventricular nicardipine, PBO2 brain oxygen tension, CBF cerebral blood flow, HH Hunt Hess, TCDS transcranial dopplers study, M male, F female