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Does intrathecal nicardipine for cerebral vasospasm following subarachnoid hemorrhage correlate with reduced delayed cerebral ischemia? A retrospective propensity score-based analysis
Journal article   Open access   Peer reviewed

Does intrathecal nicardipine for cerebral vasospasm following subarachnoid hemorrhage correlate with reduced delayed cerebral ischemia? A retrospective propensity score-based analysis

Ofer Sadan, Hannah Waddel, Reneé Moore, Chen Feng, Yajun Mei, David Pearce, Jacqueline Kraft, Cederic Pimentel, Subin Mathew, Feras Akbik, …
Journal of neurosurgery, v 136(1), 115
01 Jan 2022
DOI: https://doi.org/10.3171/2020.12.JNS203673
PMID: 34087804
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1101/2020.08.31.20185181View
SubmittedCC BY-NC-ND V4.0,  Open

Abstract

Adult Age Factors Aged Aneurysm, Ruptured Aortic Rupture - complications Aortic Rupture - surgery Calcium Channel Blockers - administration & dosage Calcium Channel Blockers - adverse effects Calcium Channel Blockers - therapeutic use Critical Care Endovascular Procedures Female Humans Injections, Spinal Male Middle Aged Neurosurgical Procedures Nicardipine - administration & dosage Nicardipine - adverse effects Nicardipine - therapeutic use Propensity Score Retrospective Studies Subarachnoid Hemorrhage - complications Treatment Outcome Vasospasm, Intracranial - drug therapy Vasospasm, Intracranial - etiology
Cerebral vasospasm and delayed cerebral ischemia (DCI) contribute to poor outcome following subarachnoid hemorrhage (SAH). With the paucity of effective treatments, the authors describe their experience with intrathecal (IT) nicardipine for this indication. Patients admitted to the Emory University Hospital neuroscience ICU between 2012 and 2017 with nontraumatic SAH, either aneurysmal or idiopathic, were included in the analysis. Using a propensity-score model, this patient cohort was compared to patients in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository who did not receive IT nicardipine. The primary outcome was DCI. Secondary outcomes were long-term functional outcome and adverse events. The analysis included 1351 patients, 422 of whom were diagnosed with cerebral vasospasm and treated with IT nicardipine. When compared with patients with no vasospasm (n = 859), the treated group was significantly younger (mean age 51.1 ± 12.4 years vs 56.7 ± 14.1 years, p < 0.001), had a higher World Federation of Neurosurgical Societies score and modified Fisher grade, and were more likely to undergo clipping of the ruptured aneurysm as compared to endovascular treatment (30.3% vs 11.3%, p < 0.001). Treatment with IT nicardipine decreased the daily mean transcranial Doppler velocities in 77.3% of the treated patients. When compared to patients not receiving IT nicardipine, treatment was not associated with an increased rate of bacterial ventriculitis (3.1% vs 2.7%, p > 0.1), yet higher rates of ventriculoperitoneal shunting were noted (19.9% vs 8.8%, p < 0.01). In a propensity score comparison to the SAHIT database, the odds ratio (OR) to develop DCI with IT nicardipine treatment was 0.61 (95% confidence interval [CI] 0.44-0.84), and the OR to have a favorable functional outcome (modified Rankin Scale score ≤ 2) was 2.17 (95% CI 1.61-2.91). IT nicardipine was associated with improved outcome and reduced DCI compared with propensity-matched controls. There was an increased need for permanent CSF diversion but no other safety issues. These data should be considered when selecting medications and treatments to study in future randomized controlled clinical trials for SAH.

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Clinical Neurology
Surgery
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