Effects of Clot Removal by Meticulous Irrigation and Continuous Low-Dose Intravenous Nicardipine on Symptomatic Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage Treated by Clipping.
BACKGROUND
Symptomatic cerebral vasospasm (SCV) is the second most common of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH) after rebleeding. Blood breakdown products are one of the leading causes of vasospasm. We hypothesized that meticulous subarachnoid clot removal in addition to continuous low-dose intravenous nicardipine (CLIN) could reduce the incidence of SCV.


METHODS
SCV was defined as new focal neurologic signs, consciousness deterioration, or both when the cause was believed to be ischemia attributable to vasospasm after other possible causes of worsening were excluded. Initial brain damage was defined as continued consciousness disturbance after clipping without acute hydrocephalus, ischemic lesions, or focal sign before clipping. Poor outcome was defined as a Glasgow Outcome Scale score of 3-5 at 30 days. We compared the variables for 460 aSAH patients with and without SCV, and with and without poor outcome by multivariate analysis.


RESULTS
All patients underwent clipping with meticulous irrigation for clot removal, and SCV was observed in 56 patients (12%). SCV was observed in 2 patients (2.9%) among 70 patients treated with CLIN. There was a higher proportion of patients who were older than 65 years (P = 0.032) and female (P = 0.038), and a lower proportion of patients with CLIN (P = 0.026) among patients with SCV. The outcomes for 109 patients (27%) were poor; age greater than 65 years (P < 0.0001) and initial brain damage (P = 0.008) were related to the poor outcomes.


CONCLUSIONS
The present study showed that meticulous irrigation for clot removal and CLIN might reduce the incidence of SCV in patients with aSAH.
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan. Electronic address: nowornever1982@gmail.com.
Hidetoshi
H
Matsukawa
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Rokuya
R
Tanikawa
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Hiroyasu
H
Kamiyama
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Toshiyuki
T
Tsuboi
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Kosumo
K
Noda
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Nakao
N
Ota
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Shiro
S
Miyata
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Go
G
Suzuki
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Rihei
R
Takeda
Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
Sadahisa
S
Tokuda
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage*; D018401:Sample Size; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000628:therapy*
D014665:Vasodilator Agents; D009529:Nicardipine
Clipping; Clot irrigation; Nicardipine; Subarachnoid hemorrhage; Symptomatic cerebral vasospasm