Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia
One of the common complications of non-traumatic subarachnoid hemorrhage (SAH) is delayed cerebral ischemia (DCI). Intrathecal (IT) administration of nicardipine, a calcium channel blocker (CCB), upon detection of large-artery cerebral vasospasm holds promise as a treatment that reduces the incidenc...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-03-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1052232/full |
| _version_ | 1797868176556425216 |
|---|---|
| author | Eashani Sathialingam Kyle R. Cowdrick Amanda Y. Liew Zhou Fang Seung Yup Lee Seung Yup Lee Courtney E. McCracken Feras Akbik Owen B. Samuels Prem Kandiah Ofer Sadan Erin M. Buckley Erin M. Buckley Erin M. Buckley |
| author_facet | Eashani Sathialingam Kyle R. Cowdrick Amanda Y. Liew Zhou Fang Seung Yup Lee Seung Yup Lee Courtney E. McCracken Feras Akbik Owen B. Samuels Prem Kandiah Ofer Sadan Erin M. Buckley Erin M. Buckley Erin M. Buckley |
| author_sort | Eashani Sathialingam |
| collection | DOAJ |
| description | One of the common complications of non-traumatic subarachnoid hemorrhage (SAH) is delayed cerebral ischemia (DCI). Intrathecal (IT) administration of nicardipine, a calcium channel blocker (CCB), upon detection of large-artery cerebral vasospasm holds promise as a treatment that reduces the incidence of DCI. In this observational study, we prospectively employed a non-invasive optical modality called diffuse correlation spectroscopy (DCS) to quantify the acute microvascular cerebral blood flow (CBF) response to IT nicardipine (up to 90 min) in 20 patients with medium-high grade non-traumatic SAH. On average, CBF increased significantly with time post-administration. However, the CBF response was heterogeneous across subjects. A latent class mixture model was able to classify 19 out of 20 patients into two distinct classes of CBF response: patients in Class 1 (n = 6) showed no significant change in CBF, while patients in Class 2 (n = 13) showed a pronounced increase in CBF in response to nicardipine. The incidence of DCI was 5 out of 6 in Class 1 and 1 out of 13 in Class 2 (p < 0.001). These results suggest that the acute (<90 min) DCS-measured CBF response to IT nicardipine is associated with intermediate-term (up to 3 weeks) development of DCI. |
| first_indexed | 2024-04-09T23:53:01Z |
| format | Article |
| id | doaj.art-e564a3507447443fa4b083e4347ab450 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T23:53:01Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-e564a3507447443fa4b083e4347ab4502023-03-17T05:50:32ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-03-011410.3389/fneur.2023.10522321052232Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemiaEashani Sathialingam0Kyle R. Cowdrick1Amanda Y. Liew2Zhou Fang3Seung Yup Lee4Seung Yup Lee5Courtney E. McCracken6Feras Akbik7Owen B. Samuels8Prem Kandiah9Ofer Sadan10Erin M. Buckley11Erin M. Buckley12Erin M. Buckley13Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United StatesWallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United StatesWallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United StatesWallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United StatesWallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United StatesDepartment of Electrical and Computer Engineering, Kennesaw State University, Marietta, GA, United StatesCenter for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, United StatesDivision of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, GA, United StatesDivision of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, GA, United StatesDivision of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, GA, United StatesDivision of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, GA, United StatesWallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United StatesDepartment of Pediatrics, School of Medicine, Emory University, Atlanta, GA, United StatesChildren's Research Scholar, Children's Healthcare of Atlanta, Atlanta, GA, United StatesOne of the common complications of non-traumatic subarachnoid hemorrhage (SAH) is delayed cerebral ischemia (DCI). Intrathecal (IT) administration of nicardipine, a calcium channel blocker (CCB), upon detection of large-artery cerebral vasospasm holds promise as a treatment that reduces the incidence of DCI. In this observational study, we prospectively employed a non-invasive optical modality called diffuse correlation spectroscopy (DCS) to quantify the acute microvascular cerebral blood flow (CBF) response to IT nicardipine (up to 90 min) in 20 patients with medium-high grade non-traumatic SAH. On average, CBF increased significantly with time post-administration. However, the CBF response was heterogeneous across subjects. A latent class mixture model was able to classify 19 out of 20 patients into two distinct classes of CBF response: patients in Class 1 (n = 6) showed no significant change in CBF, while patients in Class 2 (n = 13) showed a pronounced increase in CBF in response to nicardipine. The incidence of DCI was 5 out of 6 in Class 1 and 1 out of 13 in Class 2 (p < 0.001). These results suggest that the acute (<90 min) DCS-measured CBF response to IT nicardipine is associated with intermediate-term (up to 3 weeks) development of DCI.https://www.frontiersin.org/articles/10.3389/fneur.2023.1052232/fullvasospasmdiffuse correlation spectroscopynicardipineblood flowsubarachnoid hemorrhage |
| spellingShingle | Eashani Sathialingam Kyle R. Cowdrick Amanda Y. Liew Zhou Fang Seung Yup Lee Seung Yup Lee Courtney E. McCracken Feras Akbik Owen B. Samuels Prem Kandiah Ofer Sadan Erin M. Buckley Erin M. Buckley Erin M. Buckley Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia Frontiers in Neurology vasospasm diffuse correlation spectroscopy nicardipine blood flow subarachnoid hemorrhage |
| title | Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia |
| title_full | Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia |
| title_fullStr | Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia |
| title_full_unstemmed | Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia |
| title_short | Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia |
| title_sort | microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia |
| topic | vasospasm diffuse correlation spectroscopy nicardipine blood flow subarachnoid hemorrhage |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1052232/full |
| work_keys_str_mv | AT eashanisathialingam microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT kylercowdrick microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT amandayliew microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT zhoufang microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT seungyuplee microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT seungyuplee microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT courtneyemccracken microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT ferasakbik microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT owenbsamuels microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT premkandiah microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT ofersadan microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT erinmbuckley microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT erinmbuckley microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia AT erinmbuckley microvascularcerebralbloodflowresponsetointrathecalnicardipineisassociatedwithdelayedcerebralischemia |