Cisternal nicardipine for prevention of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a comparative retrospective cohort study

Alberto Vandenbulcke; Mahmoud Messerer; Marta Garvayo Navarro; David R Peters; Daniele Starnoni; Lorenzo Giammattei; Nawfel Ben-Hamouda; Francesco Puccinelli; Guillaume Saliou; Giulia Cossu; Roy T Daniel

doi:10.1007/s00701-024-06023-z

Cisternal nicardipine for prevention of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a comparative retrospective cohort study

Acta Neurochir (Wien). 2024 Mar 12;166(1):133. doi: 10.1007/s00701-024-06023-z.

Affiliations

¹ Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
² Department of Intensive Care, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Vaud, Switzerland.
³ Department of Radiology, Section of Neuroradiology, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland.
⁴ Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland. Roy.Daniel@chuv.ch.

^# Contributed equally.

Abstract

Purpose: Intrathecal vasoactive drugs have been proposed in patients with aneurysmal subarachnoid hemorrhage (aSAH) to manage cerebral vasospasm (CV). We analyzed the efficacy of intracisternal nicardipine compared to intraventricular administration to a control group (CG) to determine its impact on delayed cerebral ischemia (DCI) and functional outcomes. Secondary outcomes included the need for intra-arterial angioplasties and the safety profile.

Methods: We performed a retrospective analysis of prospectively collected data of all adult patients admitted for a high modified Fisher grade aSAH between January 2015 and April 2022. All patients with significant radiological CV were included. Three groups of patients were defined based on the CV management: cisternal nicardipine (CN), ventricular nicardipine (VN), and no intrathecal nicardipine (control group).

Results: Seventy patients met the inclusion criteria. Eleven patients received intracisternal nicardipine, 18 intraventricular nicardipine, and 41 belonged to the control group. No cases of DCI were observed in the CN group (p = 0.02). Patients with intracisternal nicardipine had a reduced number of intra-arterial angioplasties when compared to the control group (p = 0.03). The safety profile analysis showed no difference in complications across the three groups. Intrathecal (ventricular or cisternal) nicardipine therapy improved functional outcomes at 6 months (p = 0.04) when compared to the control group.

Conclusion: Administration of intrathecal nicardipine for moderate to severe CV reduces the rate of DCI and improved long-term functional outcomes in patients with high modified Fisher grade aSAH. This study also showed a relative benefit of cisternal over intraventricular nicardipine, thereby reducing the number of angioplasties performed in the post-treatment phase. However, these preliminary results should be confirmed with future prospective studies.

Keywords: Aneurysmal subarachnoid hemorrhage; Cerebral vasospasm; Cisternostomy; Delayed cerebral ischemia; Intrathecal nicardipine.

MeSH terms

Adult
Brain Ischemia* / drug therapy
Cerebral Infarction
Humans
Nicardipine
Prospective Studies
Retrospective Studies
Subarachnoid Hemorrhage* / complications
Vasospasm, Intracranial* / etiology

Substances

Nicardipine