The safety and efficacy of cyclosporine A in the prevention of vasospasm in patients with Fisher grade 3 subarachnoid hemorrhages: a pilot study.
OBJECTIVE
To evaluate the safety and any potential effect of cyclosporine A (CycA) in preventing cerebral vasospasm.


METHODS
Nine patients with Fisher Grade 3 subarachnoid hemorrhages were studied. After a loading dose of 7.5 mg/kg of CycA was administered every 12 hours for two doses, enteral treatment with CycA was started within 72 hours of the onset of the subarachnoid hemorrhage. Whole blood CycA levels were titrated to maintain levels of 50 to 400 ng/kg. Transcranial doppler ultrasonography was performed daily. Middle cerebral artery velocities were used to assess the degree of vasospasm. Angiography was performed to confirm the vasospasm in symptomatic patients, or it was performed if transcranial doppler ultrasonograms were unobtainable. Patients were treated with a standard pharmacological regimen of nimodipine. Induced hypertension, hemodilution, and hypervolemia were instituted at the discretion of the neurosurgical team. Intra-arterial papaverine was infused into the vasospastic vessels of three recalcitrant patients. Outcome was assessed at 6 months with the Glasgow Outcome Scale.


RESULTS
All the patients displayed evidence of vessel narrowing, which was disclosed by transcranial doppler ultrasonography or angiography. Five patients developed ischemic deficits, two were treated with intra-arterial papaverine, and three died of complications secondary to vasospasm. No significant hepatic, renal, or infectious complication developed as a result of the administration of CycA.


CONCLUSIONS
CycA proved safe to use but failed to prevent the development of cerebral vasospasm or delayed ischemic deficits in patients considered at high risk.
Manno
E M
EM
Department of Neurology, Massachusetts General Hospital, Boston, USA.
Gress
D R
DR
Ogilvy
C S
CS
Stone
C M
CM
Zervas
N T
NT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity / Q000187:drug effects; D003422:Critical Care; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010865:Pilot Projects; D013345:Subarachnoid Hemorrhage / Q000145:classification / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial / Q000187:drug effects
D007166:Immunosuppressive Agents; D016572:Cyclosporine