Use of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm.
BACKGROUND
Cerebral vasospasm leading to delayed ischemia is a common and serious complication of aneurysmal subarachnoid hemorrhage that often results in increased morbidity and mortality. Treatments for cerebral vasospasm, including triple-H therapy (therapeutic hypervolemia, hypertension, and hemodilution), nimodipine, balloon angioplasty, and intra-arterial vasodilators have limitations in their efficacy and safety profiles. Nicardipine, a calcium channel blocker, is available for intravenous administration for blood pressure reduction. A recent study reported its efficacy in the treatment of cerebral vasospasm when given intrathecally (IT). We present our experiences with IT nicardipine for treatment of cerebral vasospasm.


METHODS
IT nicardipine was administered to six patients with aneurysmal subarachnoid hemorrhage after prophylactic and aggressive therapeutic management for vasospasm failed.


RESULTS
In these patients, IT nicardipine treatment was followed within 8 hours by a 43.1 +/- 31.0 cm/s decrease in middle cerebral arterial flow velocity, as measured by transcranial Doppler ultrasound.


CONCLUSIONS
Based on these positive results, we believe that larger scale studies evaluating the safety and efficacy of IT nicardipine for the management of cerebral vasospasm are warranted.
Ehtisham
As'ad
A
Neuroscience Critical Care Unit, Via Christi Regional Medical Center, University of Kansas School of Medicine, Wichita, KS 67214, USA. aehtisham@kumc.edu
Taylor
Scott
S
Bayless
Linda
L
Samuels
Owen B
OB
Klein
Michael W
MW
Janzen
Jeff M
JM
D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology
D002121:Calcium Channel Blockers; D009529:Nicardipine