Cisternal nicardipine for prevention of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a...

Area of Science:

• Neurology
• Neurosurgery
• Pharmacology

Background:

• Cerebral vasospasm (CV) is a significant complication following aneurysmal subarachnoid hemorrhage (aSAH).
• Intrathecal vasoactive drugs are explored for CV management.
• Intracisternal nicardipine's efficacy compared to intraventricular administration requires further investigation.

Purpose of the Study:

• To evaluate the efficacy of intracisternal nicardipine versus intraventricular administration in managing CV post-aSAH.
• To assess the impact on delayed cerebral ischemia (DCI) and functional outcomes.
• To compare the need for intra-arterial angioplasties and safety profiles.

Main Methods:

• Retrospective analysis of prospectively collected data from adult patients with high modified Fisher grade aSAH (January 2015-April 2022).
• Patients categorized into three groups: cisternal nicardipine (CN), ventricular nicardipine (VN), and control group (no intrathecal nicardipine).
• Inclusion criteria: significant radiological CV.

Main Results:

• No DCI observed in the CN group (p=0.02).
• Intracisternal nicardipine group showed a reduced need for intra-arterial angioplasties compared to the control group (p=0.03).
• Intrathecal nicardipine (cisternal or ventricular) improved functional outcomes at 6 months (p=0.04).

Conclusions:

• Intrathecal nicardipine administration for moderate to severe CV reduces DCI rates and improves long-term functional outcomes in high-grade aSAH.
• Cisternal nicardipine demonstrated a relative benefit over intraventricular administration, reducing angioplasty requirements.
• Further prospective studies are recommended to confirm these findings.