Intrathecal nicardipine for cerebral vasospasm after non-traumatic subarachnoid hemorrhage: a meta-analysis

Cerebral vasospasm is a common and serious complication following non-traumatic subarachnoid hemorrhage (SAH), often leading to worsened outcomes, especially when associated with delayed cerebral ischemia (DCI). Intrathecal nicardipine has shown potential as a treatment for vasospasm, although further research is needed to establish its effectiveness and determine its role in managing this complication. A systematic search was conducted through MEDLINE, Embase, Cochrane Library, and Web of Science databases to identify studies comparing outcome measures for intrathecal nicardipine after SAH with a control group. The primary endpoints were vasospasm severity, DCI rate, and favorable outcome at 1-6 months, assessed by functional outcome scales. Secondary outcomes included mortality, infection rates, and the need for shunt placement. A total of six studies met the eligibility criteria, and a meta-analysis using a random-effects model was conducted to pool the data. In the data analyses of 2,569 patients, in comparison with standard therapy, nicardipine use has shown statistical significance in reducing the incidence of mild vasospasm (odds ratio [OR] = 0.40; 95% confidence interval [CI] [0.20, 0.80]; p = 0.010; 𝐼² = 0%), reducing mortality rate (OR = 0.58; 95% CI [0.42, 0.81]; p = 0.001; 𝐼² = 0%), and increasing infection rate, including ventriculitis and meningitis (OR = 2.54; 95% CI [1.05, 6.19]; p = 0.040; 𝐼² = 51%). The results of this present study indicate that intrathecal nicardipine may be an effective therapeutic option for reducing the severity of vasospasm and improving mortality rates in patients with non-traumatic SAH. However, it may increase the risk of infections. Further research with randomized controlled trials is needed to confirm these findings and evaluate this treatment's long-term benefits and risks.