Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm
Background: Cerebral vasospasm (CV) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. Objective: To report our institutional experience with intrathecal (IT) nicardipine for treatment of moderate to severe CV. Methods: A...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S221475192030606X |
| _version_ | 1818613443759964160 |
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| author | Jonathan M. Parish Robert Ziechmann Natalie M. Guley Jeremy Joy Brandon Karimian E. Hunter Dyer Scott D. Wait William R. Stetler Joe D. Bernard |
| author_facet | Jonathan M. Parish Robert Ziechmann Natalie M. Guley Jeremy Joy Brandon Karimian E. Hunter Dyer Scott D. Wait William R. Stetler Joe D. Bernard |
| author_sort | Jonathan M. Parish |
| collection | DOAJ |
| description | Background: Cerebral vasospasm (CV) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. Objective: To report our institutional experience with intrathecal (IT) nicardipine for treatment of moderate to severe CV. Methods: A retrospective study was performed for all patients treated with intrathecal nicardipine from October 2014-May 2017. The primary goal was to evaluate the safety of IT nicardipine to treat subarachnoid induced CV. Results.48 patients with aSAH were treated with IT nicardipine for moderate or severe CV. The average age of patients was 49.6 years (range 14–77 years) with mean Hunt Hess of 3.2 and mean Fisher scores of 3.1. Patients were treated with different dosing regiments ranging from 2 mg q12 to 4 mg q8hr. The average total dose was 35.1 mg (range 6 to 112 mg). The average initiation of treatment was post bleed day 6 (range day 2–15) and length of treatment was 5.9 days (range 1–15 days.) 10/48 (20.8%) patients underwent TBA with only 4/48 (8.3%) treated after initiation of IT nicardipine. Three patients (6.3%) developed meningitis/ventriculitis. Three (6.3%) patients required ventriculoperitoneal shunt. Favorable outcome (Glasgow Outcome Scale 4 or 5) was achieved in 56.3% of patients. Conclusions: The use of intrathecal nicardipine should be considered a safe option in the treatment of moderate to severe cerebral vasospasm. The use of intrathecal nicardipine has resulted in a near discontinuation of balloon angioplasty in our institution. Randomized trials to identify the optimal dosing, timing, and length of treatment is warranted. |
| first_indexed | 2024-12-16T16:02:12Z |
| format | Article |
| id | doaj.art-a2c47681dd3447eb87bbcaa2f0dcd973 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-16T16:02:12Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-a2c47681dd3447eb87bbcaa2f0dcd9732022-12-21T22:25:26ZengElsevierInterdisciplinary Neurosurgery2214-75192021-06-0124101045Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasmJonathan M. Parish0Robert Ziechmann1Natalie M. Guley2Jeremy Joy3Brandon Karimian4E. Hunter Dyer5Scott D. Wait6William R. Stetler7Joe D. Bernard8Department of Neurological Surgery, Carolinas Medical Center, Charlotte, NC, USA; Corresponding author at: Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC 28203, USA.Department of Neurological Surgery, Temple University, Philadelphia, PA, USADepartment of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USACarolina Neurosurgery and Spine Associates, Charlotte, NC, USACarolina Neurosurgery and Spine Associates, Charlotte, NC, USACarolina Neurosurgery and Spine Associates, Charlotte, NC, USACarolina Neurosurgery and Spine Associates, Charlotte, NC, USACarolina Neurosurgery and Spine Associates, Charlotte, NC, USACarolina Neurosurgery and Spine Associates, Charlotte, NC, USABackground: Cerebral vasospasm (CV) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. Objective: To report our institutional experience with intrathecal (IT) nicardipine for treatment of moderate to severe CV. Methods: A retrospective study was performed for all patients treated with intrathecal nicardipine from October 2014-May 2017. The primary goal was to evaluate the safety of IT nicardipine to treat subarachnoid induced CV. Results.48 patients with aSAH were treated with IT nicardipine for moderate or severe CV. The average age of patients was 49.6 years (range 14–77 years) with mean Hunt Hess of 3.2 and mean Fisher scores of 3.1. Patients were treated with different dosing regiments ranging from 2 mg q12 to 4 mg q8hr. The average total dose was 35.1 mg (range 6 to 112 mg). The average initiation of treatment was post bleed day 6 (range day 2–15) and length of treatment was 5.9 days (range 1–15 days.) 10/48 (20.8%) patients underwent TBA with only 4/48 (8.3%) treated after initiation of IT nicardipine. Three patients (6.3%) developed meningitis/ventriculitis. Three (6.3%) patients required ventriculoperitoneal shunt. Favorable outcome (Glasgow Outcome Scale 4 or 5) was achieved in 56.3% of patients. Conclusions: The use of intrathecal nicardipine should be considered a safe option in the treatment of moderate to severe cerebral vasospasm. The use of intrathecal nicardipine has resulted in a near discontinuation of balloon angioplasty in our institution. Randomized trials to identify the optimal dosing, timing, and length of treatment is warranted.http://www.sciencedirect.com/science/article/pii/S221475192030606XAneurysmal subarachnoid hemorrhageDelayed cerebral ischemiaDelayed ischemic neurologic deficitsVasospasmTransluminal balloon angioplastyEndovascular |
| spellingShingle | Jonathan M. Parish Robert Ziechmann Natalie M. Guley Jeremy Joy Brandon Karimian E. Hunter Dyer Scott D. Wait William R. Stetler Joe D. Bernard Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm Interdisciplinary Neurosurgery Aneurysmal subarachnoid hemorrhage Delayed cerebral ischemia Delayed ischemic neurologic deficits Vasospasm Transluminal balloon angioplasty Endovascular |
| title | Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm |
| title_full | Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm |
| title_fullStr | Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm |
| title_full_unstemmed | Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm |
| title_short | Safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm |
| title_sort | safety and efficacy of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage induced vasospasm |
| topic | Aneurysmal subarachnoid hemorrhage Delayed cerebral ischemia Delayed ischemic neurologic deficits Vasospasm Transluminal balloon angioplasty Endovascular |
| url | http://www.sciencedirect.com/science/article/pii/S221475192030606X |
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