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Updated: May 22, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Calcium antagonists for acute ischemic stroke
Jing Zhang1, Jie Yang, Canfei Zhang
1Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Calcium antagonists do not reduce the risk of death or dependency in acute ischemic stroke patients. Higher doses of nimodipine were linked to worse outcomes, indicating a lack of therapeutic benefit.
Area of Science:
- Neurology
- Pharmacology
- Clinical Trials
Background:
- Ischemic stroke involves a sudden loss of blood supply, leading to increased intracellular calcium ions in neurons.
- Elevated calcium levels can cause neuronal damage, potentially resulting in long-term neurological impairment, disability, and handicap.
- Inhibiting calcium influx is a potential neuroprotective strategy for stroke patients.
Purpose of the Study:
- To evaluate the efficacy of calcium antagonists in reducing death or dependency following acute ischemic stroke.
- To analyze the impact of drug type, dosage, administration route, timing, and trial design on stroke outcomes.
Main Methods:
- Systematic review and meta-analysis of 34 randomized controlled trials (RCTs) involving 7731 patients.
- Searched multiple databases including MEDLINE, EMBASE, Cochrane Library, and Chinese databases up to December 2011.
- Primary outcome: death or dependency in activities of daily living at least three months post-stroke; intention-to-treat analysis used where possible.
Main Results:
- Calcium antagonists showed no significant effect on the primary outcome of death or dependency (Risk Ratio [RR] 1.05; 95% Confidence Interval [CI] 0.98 to 1.13).
- No significant reduction in death at follow-up was observed (RR 1.07, 95% CI 0.98 to 1.17).
- Analysis of nimodipine indicated that higher doses were associated with poorer patient outcomes.
Conclusions:
- Current evidence does not support the use of calcium antagonists for treating acute ischemic stroke.
- The findings suggest a potential harm associated with higher doses of certain calcium antagonists, like nimodipine.
Background:
The sudden loss of blood supply in ischemic stroke is associated with the increase of calcium ions within neurons. Inhibiting this increase could protect neurons and hence might reduce neurological impairment, disability and handicap after stroke.
Objectives:
To determine whether calcium antagonists reduce the risk of death or dependency after acute ischemic stroke. To investigate the influence of different drugs, dosages, routes of administration, time intervals after stroke and trial design on the risk of a primary outcome.
Search Methods:
We searched the Cochrane Stroke Group Trials Register (January 2012), MEDLINE (1950 to December 2011), EMBASE (1980 to December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2011 issue 4) and four Chinese databases (December 2011): Chinese Biological Medicine Database (CBM-disc), China National Knowledge Infrastructure (CNKI), Chinese scientific periodical database of VIP information and Wanfang Data. We also contacted trialists and researchers.
Selection Criteria:
All truly randomized trials comparing a calcium antagonist with control in patients with acute ischemic stroke.
Data Collection And Analysis:
Two authors assessed all trials and extracted the data. We used death or dependency at the end of long-term follow-up (at least three months) in activities of daily living as the primary outcome. Analyses were, if possible, intention-to-treat.
Main Results:
We included 34 trials including 7731 patients. There was no effect of calcium antagonists on the primary outcome (risk ratio (RR) 1.05; 95% confidence interval (CI) 0.98 to 1.13), or on death at the end of follow-up (RR 1.07, 95% CI 0.98 to 1.17). Comparisons of different doses of nimodipine suggested that the highest doses were associated with poorer outcome.
Authors' Conclusions:
No evidence is available using calcium antagonists in patients with acute ischemic stroke is effective.
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