Saturday, December 17, 2011

Intraventricular Nicardipine for Aneurysmal Subarachnoid Hemorrhage Related Vasospasm: Assessment of

Abstract
Background  
Delayed cerebral arterial vasospasm is one of the leading causes of death and disability after aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the safety of intraventricular nicardipine (IVN) for vasospasm (VSP) in aSAH patients, and outcomes compared with a control population.
Methods  
A retrospective case–control study was conducted for aSAH patients treated with IVN at Mayo Clinic, Jacksonville, FL, from March 2009 to January 2011. Controls were matched by age, gender, and Fisher grade. Safety was evaluated by the incidence of intracranial bleeding and infection. Outcome was measured by Glasgow Outcome Scale at 30 and 90 days. IVN effects on VSP were evaluated by transcranial Doppler (TCD).
Results  
Thirteen aSAH patients and one arteriovenous malformation (AVM)-related SAH patient received IVN for VSP and were matched with 14 aSAH patients without IVN therapy for a total of 28 cases. Median dose was 4 mg (range 3–7), and median number of doses was seven (range 1–17). Mean flow velocity decreased after IVN (120.2 and 101.6 cm/s–82.0 and 72.8 cm/s, right and left middle cerebral arteries, respectively). No significant difference was seen in clinical outcomes between controls and cases at 30 days (P = 0.443) and 90 days (P = 0.153). There were no incidences of bleeding or infection with 111 nicardipine injections.
Conclusions  
IVN appears relatively safe and effective in treating VSP by TCD, but there was no difference in clinical outcomes between nicardipine and control patients at 30 and 90 days. In the future, larger studies are needed to evaluate the clinical outcome with IVN.

  • Content Type Journal Article
  • Category Original Article
  • Pages 1-8
  • DOI 10.1007/s12028-011-9659-8
  • Authors
    • Na Lu, Clinical Research Internship Study Program (CRISP), Mayo Clinic, Jacksonville, FL, USA
    • Daniel Jackson, Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA
    • Sothear Luke, Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
    • Emir Festic, Department of Critical Care, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
    • Ricardo A. Hanel, Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
    • William David Freeman, Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA





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