Intraventricular Nicardipine for Refractory Cerebral Vasospasm after Subarachnoid Hemorrhage

Goodson, K. H.; Lapointe, Marc; Monroe, Timothy; Chalela, Julio A.

doi:10.1007/s12028-007-9017-z

Cited by 49 publications

(31 citation statements)

References 25 publications

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“…However, the dose of 4 mg was diluted in 2 ml of preservative free saline instead of 10 ml to minimize the volume injected into the intraventricular space. This dosing is similar to that described by Goodson et al and Ehtisham et al [10,11]. The optimal concentration of nicardipine in the CSF is not known.…”

Section: Dayssupporting

confidence: 71%

“…Similar series have reported on the use of nicardipine prolonged release implants [12,13]. Recently, Goodson et al and Ehtisham et al [10,11] have reported their successful experience with intraventricular administration of nicardipine in patients with vasospasm refractory to conventional treatments. Intraventricular administration of nicardipine is particularly appealing in patients with aSAH as many of these patients have ventricular drains in place.…”

Section: Discussionmentioning

confidence: 71%

“…A potential alternative is to administer nicardipine locally to the cerebral vasculature, either by intra-arterial administration [6], intrathecal/intraventricular administration [7][8][9][10][11], or by the surgical application of prolonged release implants [12,13].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Intraventricular Administration of Nicardipine on Mean Cerebral Blood Flow Velocity Measured by Transcranial Doppler in the Treatment of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

et al. 2009

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Intraventricular nicardipine was associated with a significant and sustained reduction in mean cerebral blood flow velocity as measured by transcranial Doppler when used in the treatment of suspected cerebral vasospasm following aneurysmal subarachnoid hemorrhage. We do not find significant safety concerns related to elevations of intracranial pressure or ventricular catheter related infections. Further prospective studies are warranted to better determine the efficacy and safety of this therapy.

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Section: Dayssupporting

confidence: 71%

Section: Discussionmentioning

confidence: 71%

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The Effect of Intraventricular Administration of Nicardipine on Mean Cerebral Blood Flow Velocity Measured by Transcranial Doppler in the Treatment of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

et al. 2009

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“…The safety and efficacy of intrathecal nicardipine for the prevention and treatment of SAH-induced vasospasm has been clearly demonstrated in the clinical setting [58,119,133,134,135,136,137,138,139,140]. Shibuya et al [135] reported the effects of prophylactic serial administration of intrathecal nicardipine on vasospasm in 50 Fisher grade III SAH patients.…”

Section: Novel and Alternative Therapies For Sah-induced Cerebral Vasmentioning

confidence: 99%

Current Options for the Management of Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm: A Comprehensive Review of the Literature

2013

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Objectives: Cerebral vasospasm is one of the leading causes of morbi-mortality following aneurysmal subarachnoid hemorrhage. The aim of this article is to discuss the current status of vasospasm therapy with emphasis on endovascular treatment. Methods: A comprehensive review of the literature obtained by a PubMed search. The most relevant articles related to medical, endovascular and alternative therapies were selected for discussion. Results: Current accepted medical options include the oral nimodipine and ‘triple-H' therapy (hypertension, hypervolemia and hemodilution). Nimodipine remains the only modality proven to reduce the incidence of infarction. Although widely used, ‘triple-H' therapy has not been demonstrated to significantly change overall outcome after cerebral vasospasm. Indeed, both induced hypervolemia and hemodilution may have deleterious effects, and more recent physiologic data favor normovolemia with induced hypertension or optimization of cardiac output. Endovascular options include percutaneous transluminal balloon angioplasty (PTA) and intra-arterial (IA) infusion of vasodilators. Multiple case reports and case series have been encountered in the literature using different drug regimens with diverse mechanisms of action. Compared with PTA, IA drug infusion has the advantages of distal penetration and a better safety profile. Its main disadvantages are the more frequent need for repeat treatments and its systemic hemodynamic repercussions. Alternative options using intraventricular/cisternal drug therapy and flow augmentation strategies have also shown possible benefits; however, their use is not yet as well established. Conclusion: Blood pressure or cardiac output optimization should be the mainstay of hyperdynamic therapy. Endovascular treatment appears to have a positive impact on neurological outcome compared with the natural history of the disease. The role of intraventricular therapy and flow augmentation strategies in association with medical and endovascular treatment may, in the future, play a growing role in the management of patients with severe refractory vasospasm.

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“…The drug was well tolerated, and 7 of the 8 patients had moderate to good functional outcomes. 118 A potential novel option for administering nicardipine is the insertion of nicardipine-releasing implants at the time of surgical intervention. A phase II prospective, randomized, double-blind evaluation of nicardipine prolonged release implants in 32 patients demonstrated that nicardipine was more effective than placebo at reducing the incidence of vasospasm (7% vs 73%; P < .05) and delayed cerebral ischemia (14% vs 47%; P < .05).…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

Cerebral Vasospasm in Critically III Patients with Aneurysmal Subarachnoid Hemorrhage: Does the Evidence Support the Ever-Growing List of Potential Pharmacotherapy Interventions?

Kiser

2014

Hosp Pharm

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The occurrence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a significant event resulting in decreased cerebral blood flow and oxygen delivery. Prevention and treatment of cerebral vasospasm is vital to avert neurological damage and reduced functional outcomes. A variety of pharmacotherapy interventions for the prevention and treatment of cerebral vasospasm have been evaluated. Unfortunately, very few large randomized trials exist to date, making it difficult to make clear recommendations regarding the efficacy and safety of most pharmacologic interventions. Considerable debate exists regarding the efficacy and safety of hypervolemia, hemodilution, and hypertension (triple-H therapy), and the implementation of each component varies substantially amongst institutions. There is a new focus on euvolemic-induced hypertension as a potentially preferred mechanism of hemodynamic augmentation. Nimodipine is the one pharmacologic intervention that has demonstrated favorable effects on patient outcomes and should be routinely administered unless contraindications are present. Intravenous nicardipine may offer an alternative to oral nimodipine. The addition of high-dose magnesium or statin therapy has shown promise, but results of ongoing large prospective studies are needed before they can be routinely recommended. Tirilazad and clazosentan offer new pharmacologic mechanisms, but clinical outcome results from prospective randomized studies have largely been unfavorable. Locally administered pharmacotherapy provides a targeted approach to the treatment of cerebral vasospasm. However, the paucity of data makes it challenging to determine the most appropriate therapy and implementation strategy. Further studies are needed for most pharmacologic therapies to determine whether meaningful efficacy exists.

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Intraventricular Nicardipine for Refractory Cerebral Vasospasm after Subarachnoid Hemorrhage

Cited by 49 publications

References 25 publications

The Effect of Intraventricular Administration of Nicardipine on Mean Cerebral Blood Flow Velocity Measured by Transcranial Doppler in the Treatment of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

The Effect of Intraventricular Administration of Nicardipine on Mean Cerebral Blood Flow Velocity Measured by Transcranial Doppler in the Treatment of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Current Options for the Management of Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm: A Comprehensive Review of the Literature

Cerebral Vasospasm in Critically III Patients with Aneurysmal Subarachnoid Hemorrhage: Does the Evidence Support the Ever-Growing List of Potential Pharmacotherapy Interventions?

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