Intrathecal administration of nicardipine hydrochloride to prevent vasospasm in patients with subarachnoid hemorrhage

Suzuki, Michiyasu; Doi, Mamoru; Otawara, Yasunari; Ogasawara, Kuniaki; Ogawa, Akira

doi:10.1007/s101430100152

Cited by 48 publications

(37 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…surgery without the need for further interventions avoiding serious side effects. 17,18 The results of the present study confirm the safety of NPRIs.…”

Section: Discussionsupporting

confidence: 75%

Effect of Nicardipine Prolonged-Release Implants on Cerebral Vasospasm and Clinical Outcome After Severe Aneurysmal Subarachnoid Hemorrhage

Barth

Capelle

Weidauer

et al. 2007

Stroke

136

View full text Add to dashboard Cite

Background and Purpose-The purpose of this study was to investigate the effect of nicardipine prolonged-release implants (NPRIs) on cerebral vasospasm and clinical outcome after severe subarachnoid hemorrhage. Methods-Thirty-two patients with severe subarachnoid hemorrhage and undergoing aneurysm clipping were included into this single center, randomized, double-blind trial. Sixteen patients received NPRIs implanted into the basal cisterns in direct contact to the exposed proximal blood vessels; in 16 control patients, the basal cisterns were opened and washed out only without leaving implants. Angiography was performed preoperatively and at day 8Ϯ1. Computed tomography imaging was analyzed for the incidence of territorial infarcts unrelated to surgery. Patient outcome was assessed using the modified Rankin and National Institute of Health Stroke scales. Results-The incidence of angiographic vasospasm in proximal vessel segments was significantly reduced after implantation of NPRIs (73% control versus 7% NPRIs). Significant differences occurred also for the majority of distal vessel segments. Computed tomography scans revealed a lower incidence of delayed ischemic lesions (47% control versus 14% NPRIs). The NPRI group demonstrated more favorable modified Rankin and National Institute of Health Stroke scales as well as a significantly lower incidence of deaths (38% control versus 6% NPRIs). Conclusions-Implantation of NPRIs reduces the incidence of cerebral vasospasm and delayed ischemic deficits and improves clinical outcome after severe subarachnoid hemorrhage. Key Words: nicardipine prolonged-release implants Ⅲ SAH Ⅲ stroke Ⅲ vasospasm C erebral vasospasm remains one of the most serious complications after aneurysmal subarachnoid hemorrhage (SAH). Over the past decades, several pharmacological approaches have been investigated for the prevention of cerebral vasospasm. Among those, the most prominent is the use of voltage-gated calcium channel antagonists such as nimodipine and nicardipine. Experimental data support the concept that voltage-gated calcium channel antagonists are capable of preventing cerebral vasospasm if administered in high enough doses to the vessel wall. 1 However, when administered intravenously or orally, the doses necessary to exert maximum pharmacological effect cannot be achieved as a result of the side effects of the drug. [2][3][4] Recently, this limitation in the delivery of voltage-gated calcium channel antagonists has been overcome by the introduction of nicardipine prolonged-release implants (NPRIs). These nicardipine-loaded polymers are implanted into the basal cisterns in close contact to the proximal cerebrovascular system at the time of aneurysm clipping and release the drug over 14 days. Thereby, nicardipine is delivered locally at a high and constant concentration to the cerebral blood vessel wall, at the same time avoiding systemic side effects.The initial preclinical and clinical experiences with NPRIs have been promising and have failed to show toxicity. [2][3][4] In a re...

show abstract

“…surgery without the need for further interventions avoiding serious side effects. 17,18 The results of the present study confirm the safety of NPRIs.…”

Section: Discussionsupporting

confidence: 75%

Effect of Nicardipine Prolonged-Release Implants on Cerebral Vasospasm and Clinical Outcome After Severe Aneurysmal Subarachnoid Hemorrhage

Barth

Capelle

Weidauer

et al. 2007

Stroke

136

View full text Add to dashboard Cite

show abstract

“…20,23) In our case, the clinical symptoms progressed despite antibiotic administration with hypervolemic therapy, hyperdynamic therapy, and corticosteroid administration. Intrathecal administration of nicardipine was also carried out for possible vasospasm involvement, 19) which was also ineffective.…”

Section: Discussionmentioning

confidence: 99%

“…Since therapy resistant and delayed vasospasm was initially suspected, a spinal drainage tube was introduced for intrathecal administration of nicardipine. 19) Moreover, steroid pulse therapy was carried out with 1000 mg/day of hydrocortisone for possible involvement of inflammatory mechanisms. In spite of such intensive treatments, her symptom gradually aggravated and diffusion-weighted MR imaging showed a hyperintense le-T. Kawaguchi et al…”

Section: Case Reportmentioning

confidence: 99%

Cerebral Arteritis With Extremely Late Onset Secondary to Bacterial Meningitis -Case Report-

Kawaguchi

Ogawa

Inoue

et al. 2011

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

A 59-year-old woman presented with bacterial meningitis causing arterial narrowing in the very late stage. She initially underwent transsphenoidal surgery for massive non-functioning pituitary adenoma resulting in gross total removal. The postoperative course was uneventful, and she was discharged 12 days after surgery. Fourteen months later, she presented with bacterial meningitis due to streptococcus. Administration of multiple antibiotics resulted in normalization of cerebrospinal fluid findings. Forty days after meningitis onset, she suddenly suffered motor weakness of the right extremities. Magnetic resonance (MR) angiography revealed multiple intracranial arterial narrowings. Despite intensive treatment, no improvement of arterial narrowing was seen, and she suffered cerebral infarction. Six months after the onset of meningitis, MR angiography still showed multiple arterial narrowings, and MR plaque imaging of the stenotic vessel disclosed thickened arterial wall. This case illustrates the complex time course of arteritis caused by severe bacterial meningitis, and the intractability to treatment.

show abstract

“…El nicardipino ha demostrado su eficacia para prevenir el vasospasmo en otras formas de administración como la infusión intratecal y la colocación de implantes de liberación lenta en el espacio subaracnoideo 39,40 . Para su administración intraarterial, se diluye en suero salino hasta una concentración de 0,1 mg/ml y se infunde, vía microcateterización superselectiva del territorio arterial afectado, en dosis sucesivas de 1 ml hasta un máximo de 5 mg por vaso 41 .…”

Section: Nicardipinounclassified

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Alcázar

González

Romance³

2008

Medicina Intensiva

View full text Add to dashboard Cite

El vasospasmo cerebral es una de las principales causas de morbimortalidad en los pacientes con hemorragia subaracnoidea por rotura de un aneurisma cerebral. Cuando el vasospasmo se hace resistente al tratamiento médico máximo, el tratamiento endovascular es una opción terapéu-tica para incrementar el flujo sanguíneo cerebral y evitar lesiones isquémicas cerebrales. Los rápi-dos avances en técnicas endovasculares permiten utilizar la angioplastia transluminal percutá-nea y la infusión intraarterial de diversos fármacos vasodilatadores para revertir el vasospasmo. En este artículo se revisan las diferentes técnicas endovasculares disponibles y se describen sus mecanismos de acción, técnicas de administración, resultados clínicos y complicaciones. ENDOVASCULAR TREATMENT OF CEREBRAL VASOSPASM DUE TO ANEURYSMAL SUBARACHNOID HEMORRHAGECerebral vasospasm remains a leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. When vasospasm becomes refractory to maximal medical treatment, endovascular therapies may be considered as an option to increase cerebral blood flow to prevent cerebral infarction. Endovascular techniques include transluminal balloon angioplasty and intraarterial infusion of vasorelaxants.This article reviews the various endovascular techniques for the treatment of cerebral vasospasm and discusses the mechanisms of action, techniques of administration, clinical results, and limitations of these treatment strategies.

show abstract

Intrathecal administration of nicardipine hydrochloride to prevent vasospasm in patients with subarachnoid hemorrhage

Abstract: These results suggest that our strategy may well prevent VS. However, hydrocephalus and infection may be serious disadvantages that should be resolved.

Cited by 48 publications

References 36 publications

Effect of Nicardipine Prolonged-Release Implants on Cerebral Vasospasm and Clinical Outcome After Severe Aneurysmal Subarachnoid Hemorrhage

Effect of Nicardipine Prolonged-Release Implants on Cerebral Vasospasm and Clinical Outcome After Severe Aneurysmal Subarachnoid Hemorrhage

Cerebral Arteritis With Extremely Late Onset Secondary to Bacterial Meningitis -Case Report-

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Contact Info

Product

Resources

About