title: A simplified method for administration of intra-arterial nicardipine for vasospasm with cervical catheter infusion.
abstract: BACKGROUND
  Cerebral vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage. Nicardipine has previously been used to treat vasospasm through superselective intracranial microcatheter injections.
  
  
  OBJECTIVE
  To evaluate a simple method of treatment of vasospasm with slow infusion of nicardipine from a cervical catheter.
  
  
  METHODS
  Twenty-seven patients with symptomatic vasospasm were treated over 4 years with cervical catheter infusions. Nicardipine was infused at 20 mg/h for 30 to 60 minutes. Angioplasty was used in severe cases at the operator's discretion. Outcome at discharge and follow-up was evaluated with Glasgow Outcome Scale.
  
  
  RESULTS
  Twenty-seven patients (17 women, 12 men) received intra-arterial therapy for vasospasm. Vasospasm treatment was done at a mean post-hemorrhage date of 7.2 days (range, 4-15 days). They underwent 48 sessions of treatment (mean, 1.8 per patient) in 72 separate arterial territories. Twelve patients underwent multiple treatments. The mean dose used per session was 19.2 mg (range, 5-50 mg). Four patients underwent angioplasty for severe vasospasm. Twenty-two patients (81.5%) had clinical improvement after the infusion. Angiographic improvement was seen in 86.1% of the vessels analyzed, which had moderate or severe spasm before infusion. Overall, 17 patients (62.9%) had good outcome (Glasgow Outcome Scale score, 4 and 5) at discharge, 11 had poor outcome, and 1 patient died. Follow-up was available in 19 patients, and 18 were doing well (Glasgow Outcome Scale score, 4 and 5).
  
  
  CONCLUSIONS
  Intra-arterial nicardipine is an effective and safe treatment for cerebral vasospasm. In most patients, infusion can be performed from the cervical catheter, with microcatheter infusion and angioplasty reserved for the more severe and resistant cases.
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305-5105, USA.
authors: Paritosh
authors: P
authors: Pandey
authors: Gary K
authors: GK
authors: Steinberg
authors: Robert
authors: R
authors: Dodd
authors: Huy M
authors: HM
authors: Do
authors: Michael P
authors: MP
authors: Marks
mesh_terms: D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D009529:Nicardipine / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D020301:Vasospasm, Intracranial / Q000188:drug therapy*
chemical_list: D014665:Vasodilator Agents; D009529:Nicardipine