title: The use of nicardipine prolonged release implants (NPRI) in microsurgical clipping after aneurysmal subarachnoid haemorrhage: comparison with endovascular treatment.
abstract: BACKGROUND
  Nicardipine prolonged release implants (NPRI) have been shown to decrease the incidence of cerebral vasospasm and infarcts significantly in patients after aneurysmal subarachnoid haemorrhage (SAH) following microsurgical clipping. Yet, the comparison with results after endovascular coiling is lacking. This study was conducted to determine the differences in the incidence of cerebral vasospasm and infarctions between those two treatment modalities
  
  
  METHODS
  The design of this investigation reflects a case-control study; 27 patients suffering from acute SAH were treated by microsurgical clipping and received an intracisternal implantation of NPRI. Twenty-seven matching consecutive patients after microsurgical treatment without implantation of NPRI or endovascular treatment, respectively, served as controls. The incidence of angiographic vasospasm and cerebral infarctions were documented.
  
  
  RESULTS
  All groups were comparable concerning demographics and severity of SAH. Twenty-four of 81 patients developed angiographic vasospasm (>33% constriction). The incidence of vasospasm was 48%, 44% and 11% for patients after endovascular treatment, microsurgical clipping without NPRI and microsurgical clipping with NPRI, respectively. New cerebral infarctions occurred in 28%, 22% and 7% of the treated patients, respectively. A good clinical recovery 1 year after the initial bleeding (modified Rankin scale 0-2) was seen in 48%, 50% and 77% of the treated patients, respectively.
  
  
  CONCLUSIONS
  The use of NPRI during microsurgical clipping was confirmed to be safe and effective. Patients who received intracisternally implanted NPRI during clipping after aneurysmal SAH yielded significantly lower vasospasm and infarction rates, and showed a better clinical outcome when compared with clipping without NPRI and also when compared with endovascular coiling.
authors.affiliation: Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Germany.
authors.forename: Ulf C
authors.initials: UC
authors.lastname: Schneider
authors.forename: Stefanie
authors.initials: S
authors.lastname: Dreher
authors.forename: Karl-Titus
authors.initials: KT
authors.lastname: Hoffmann
authors.forename: Peter
authors.initials: P
authors.lastname: Schmiedek
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kasuya
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
mesh_terms: D016022:Case-Control Studies; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004343:Drug Implants / Q000032:analysis / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery*; D013346:Subarachnoid Space / Q000033:anatomy & histology / Q000187:drug effects / Q000601:surgery*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
chemical_list: D003692:Delayed-Action Preparations; D004343:Drug Implants; D014665:Vasodilator Agents; D009529:Nicardipine