Related Experiment Video
Updated: Oct 25, 2025
Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
Published on: June 18, 2021
Nicardipine Prolonged Release Implants for Prevention of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid
Feras Akbik1, Hannah Waddel2, Blessing N R Jaja3
1Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, USA.
Insights
Nicardipine prolonged release implants (NPRI) significantly reduce delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). While functional outcomes showed a trend toward improvement, further randomized trials are needed.
Area of Science:
- Neurosurgery
- Neurology
- Pharmacology
Background:
- Delayed cerebral ischemia (DCI) is a major cause of poor recovery after aneurysmal subarachnoid hemorrhage (aSAH).
- Nicardipine is a vasodilator with off-label use for preventing vasospasm and DCI.
- Nicardipine prolonged release implants (NPRI) offer localized, sustained delivery during surgery.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of NPRI in preventing DCI after aSAH.
- To assess the impact of NPRI on functional outcomes in aSAH patients.
Main Methods:
- Systematic search of PubMed, Embase, and Cochrane databases for studies on NPRI in aSAH.
- Random effects model meta-analysis for studies with control arms (284 patients).
- Network meta-analysis including single-arm NPRI studies and control arms from RCTs (866 patients).
Main Results:
- NPRI was associated with a significant reduction in DCI (OR 0.21, p=0.0002 in random effects model; OR 0.30, p=0.017 in network meta-analysis).
- No significant difference in functional outcomes was observed (OR 1.80, p=0.28; OR 1.68, p=0.101 trend).
- The search identified 214 unique citations, with 3 and 10 studies included in the respective analyses.
Conclusions:
- NPRI effectively decreases the incidence of DCI following aSAH.
- A non-significant trend towards improved functional outcomes suggests potential benefit.
- Randomized trials are warranted to prospectively evaluate intrathecal calcium channel blockers like NPRI.
Objectives:
A paucity of treatments to prevent delayed cerebral ischemia (DCI) has stymied recovery after aneurysmal subarachnoid hemorrhage (aSAH). Nicardipine has long been recognized as a potent cerebrovascular vasodilator with a history off-label use to prevent vasospasm and DCI. Multiple centers have developed nicardipine prolonged release implants (NPRI) that are directly applied during clip ligation to locally deliver nicardipine throughout the vasospasm window. Here we perform a systematic review and meta-analysis to assess whether NPRI confers protection against DCI and improves functional outcomes after aSAH.
Materials And Methods:
A systematic search of PubMed, Ovid Embase, and Cochrane databases was performed for studies reporting the use of NPRI after aSAH published after January 1, 1980. We included all studies assessing the association of NPRI with DCI and or functional outcomes. Findings from studies with control arms were analyzed using a random effects model. A separate network meta-analysis was performed, including controlled NPRI studies, single-arm NPRI reports, and the control-arms of modern aSAH randomized clinical trials as additional comparators.
Results:
The search identified 214 unique citations. Three studies with 284 patients met criteria for the random effects model. The pooled summary odds ratio for the association of NPRI and DCI was 0.21 (95% CI 0.09-0.49, p = 0.0002) with no difference in functional outcomes (OR 1.80, 95% CI 0.63 - 5.16, p = 0.28). 10 studies of 866 patients met criteria for the network meta-analysis. The pooled summary odds ratio for the association of NPRI and DCI was 0.30 (95% CI 0.13-0.89,p = 0.017) with a trend towards improved functional outcomes (OR 1.68, 0.63 - 4.13 95% CI, p = 0.101).
Conclusions:
In these meta-analyses, NPRI decreases the incidence of DCI with a non-significant trend towards improvement in functional outcomes. Randomized trials on the role of intrathecal calcium channel blockers are warranted to evaluate these observations in a prospective manner.
More Related Videos
Related Concept Videos
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:22Aneurysm IV: Nursing Management
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:27Coronary Artery Disease V: Interprofessional Care