title: High-dose intra-arterial nicardipine results in hypotension following vasospasm treatment in subarachnoid hemorrhage.
abstract: BACKGROUND
  Intra-arterial (IA) nicardipine is often used to treat cerebral vasospasm associated with subarachnoid hemorrhage (SAH). While hypotension has been noted to be a dose-limiting side effect of intravenous infusions, this has seldom been reported for IA administration.
  
  
  METHODS
  We reviewed a consecutive series of patients who received IA nicardipine for SAH-associated vasospasm. Nicardipine was titrated to angiographic response, with blood pressure and intracranial pressure monitoring. We analyzed data using Wilcoxon signed rank, Student's t-test, Spearman's correlation, and χ(2) statistics as appropriate. A P value <0.05 was considered significant.
  
  
  RESULTS
  Thirty patients underwent 50 procedures in which nicardipine was the sole chemical vasodilator (median dose, 15 mg). Median mean arterial pressures (MAP) decreased from 118 to 100 mmHg (P < 0.001), with an intra-operative low of 80 mmHg. Both intra-operative and post-operative decreases in MAP were directly related to nicardipine dose (r                            (s) = 0.352, P = 0.022 and r                            (s) = 0.308, P = 0.047, respectively). Hypotension (MAP < 70 mmHg) occurred in 22%, and 44% required initiation of or increases in vasopressor therapy. After the first treatment, 11 of 16 patients treated with vasodilator therapy alone, and 5 of 14 patients who underwent additional balloon angioplasty (68.8 vs. 35.7%, P = 0.141), required further endovascular treatments due to recurrent vasospasm on subsequent days.
  
  
  CONCLUSIONS
  Intra-arterial nicardipine is associated with significant intra-operative blood pressure lowering, an increased requirement for intra-operative vasopressor therapy, and a tendency toward re-treatment when used as initial monotherapy for vasospasm.
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison St., Suite 1121, Chicago, IL 60612, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Rosenberg
authors.forename: Marc A
authors.initials: MA
authors.lastname: Lazzaro
authors.forename: Demetrius K
authors.initials: DK
authors.lastname: Lopes
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002533:Cerebral Angiography; D002941:Circle of Willis / Q000000981:diagnostic imaging / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D007261:Infusions, Intra-Arterial; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage* / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009529:Nicardipine