Angiographic and hemodynamic effect of high concentration of intra-arterial nicardipine in cerebral vasospasm.
OBJECTIVE
Nicardipine has been used to treat cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intra-arterial (IA) infusion of high concentrations of nicardipine decreases procedure time, but it may affect hemodynamic parameters. In addition, a quantitative measurement of improvement of vessel diameter on the angiograms has not been performed.


METHODS
We conducted a single-center, retrospective database analysis of consecutive patients with symptomatic vasospasm after aneurysmal subarachnoid hemorrhage who failed medical management and received IA nicardipine between September 2005 and June 2006. Nicardipine (1 mg/mL/min) was infused intra-arterially by microcatheter. Blood pressure, heart rate, and intracranial pressure were recorded during the infusion. The effect of IA nicardipine on the vessel's diameter was measured on angiography by two blinded investigators.


RESULTS
Forty-six treatment sessions were performed in 22 consecutive patients (13 women; age, 56.4 +/-13 years). Fourteen patients received IA nicardipine alone, and 8 patients had additional angioplasty. The average nicardipine dose was 12 +/- 10 mg (range, 2-25 mg). The mean decrease of systolic, diastolic, and mean blood pressure was 17.4 +/- 18.3 mm Hg, 7.7 +/- 10.4 mm Hg, and 10.9 +/- 11.6 mm Hg, respectively. There was no change in intracranial pressure. Measurement of 49 vessels in the 14 patients treated with nicardipine alone showed a significant increase in arterial diameters (range, 1-74%; P < 0.0001). At the time of discharge, 11 patients (50%) were functionally independent (modified Rankin Scale score, 0-2).


CONCLUSIONS
High concentrations of IA nicardipine infusion have a reversible effect on blood pressure and heart rate. IA nicardipine results also in a significant improvement in vessel diameter in patients with vasospasm after aneurysmal subarachnoid hemorrhage.
Linfante
Italo
I
Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA. ItaloL@baptisthealth.net
Delgado-Mederos
Raquel
R
Andreone
Vincenzo
V
Gounis
Matthew
M
Hendricks
Laura
L
Wakhloo
Ajay K
AK
D000792:Angiography / Q000379:methods*; D001783:Blood Flow Velocity / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000187:drug effects; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*
D002121:Calcium Channel Blockers; D009529:Nicardipine