title: Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm.
abstract: OBJECTIVE
  Papaverine is the primary intra-arterial (IA) treatment for vasospasm after aneurysmal subarachnoid hemorrhage (SAH); however, is it limited in effect and by adverse effects. We prospectively studied the use of IA nicardipine as a treatment for vasospasm.
  
  
  METHODS
  Over 12 months, all patients with SAH who required interventional treatment for vasospasm were given IA nicardipine with or without angioplasty. Vasospasm was determined by serial clinical assessments and/or daily transcranial Doppler (TCD) imaging and confirmed by angiography. Doses of IA nicardipine per vessel were 0.5-6 mg. All patients were monitored for increased intracranial pressure (ICP) and change in cardiovascular or neurologic status.
  
  
  RESULTS
  Forty-four vessels in 18 patients with vasospasm were treated with IA nicardipine alone. TCD data for 38 vessels (15 cases) were available. All vessels demonstrated immediate angiographic dilatation after IA nicardipine. No sustained cardiovascular changes were after treatment. ICP was transiently elevated in five patients and persistently elevated in one. Mean peak systolic velocities at TCD imaging were significantly reduced from pretreatment values in all treated vessels for 4 days after infusion (268.9 +/- 77.8 vs 197.6 +/- 74.1 cm/s, P <.001). Neurologic improvement after IA nicardipine occurred in eight (42.1%) patients. No clinical deterioration was noted.
  
  
  CONCLUSIONS
  As shown by TCD imaging, IA nicardipine has an immediate and sustained effect on vasospasm. It does not appear to have sustained effect on ICP or cardiovascular status. This treatment warrants further study to determine its safety and efficacy.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Mehmet A
authors.initials: MA
authors.lastname: Topcuoglu
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Pryor
authors.forename: James D
authors.initials: JD
authors.lastname: Rabinov
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.forename: Bob S
authors.initials: BS
authors.lastname: Carter
authors.forename: Guy A
authors.initials: GA
authors.lastname: Rordorf
mesh_terms: D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage*; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D002121:Calcium Channel Blockers; D009529:Nicardipine