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Nicardipine Prolonged Release Implants for Prevention of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis
Journal article   Peer reviewed

Nicardipine Prolonged Release Implants for Prevention of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis

Feras Akbik, Hannah Waddel, Blessing N.R. Jaja, R. Loch Macdonald, Renee Moore, Owen B. Samuels and Ofer Sadan
Journal of stroke and cerebrovascular diseases, v 30(10), 106020
Oct 2021
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106020
PMID: 34365121
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Aneurysmal subarachnoid hemorrhage Cerebral vasospasm Delayed cerebral ischemia Meta-analysis Nicardipine Nicardipine pellets Nicardipine prolonged release implants
A paucity of treatments to prevent delayed cerebral ischemia (DCI) has stymied recovery after aneurysmal subarachnoid hemorrhage (aSAH). Nicardipine has long been recognized as a potent cerebrovascular vasodilator with a history off-label use to prevent vasospasm and DCI. Multiple centers have developed nicardipine prolonged release implants (NPRI) that are directly applied during clip ligation to locally deliver nicardipine throughout the vasospasm window. Here we perform a systematic review and meta-analysis to assess whether NPRI confers protection against DCI and improves functional outcomes after aSAH. A systematic search of PubMed, Ovid Embase, and Cochrane databases was performed for studies reporting the use of NPRI after aSAH published after January 1, 1980. We included all studies assessing the association of NPRI with DCI and or functional outcomes. Findings from studies with control arms were analyzed using a random effects model. A separate network meta-analysis was performed, including controlled NPRI studies, single-arm NPRI reports, and the control-arms of modern aSAH randomized clinical trials as additional comparators. The search identified 214 unique citations. Three studies with 284 patients met criteria for the random effects model. The pooled summary odds ratio for the association of NPRI and DCI was 0.21 (95% CI 0.09–0.49, p = 0.0002) with no difference in functional outcomes (OR 1.80, 95% CI 0.63 – 5.16, p = 0.28). 10 studies of 866 patients met criteria for the network meta-analysis. The pooled summary odds ratio for the association of NPRI and DCI was 0.30 (95% CI 0.13–0.89,p = 0.017) with a trend towards improved functional outcomes (OR 1.68, 0.63 – 4.13 95% CI, p = 0.101). In these meta-analyses, NPRI decreases the incidence of DCI with a non-significant trend towards improvement in functional outcomes. Randomized trials on the role of intrathecal calcium channel blockers are warranted to evaluate these observations in a prospective manner.

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9 citations in Web of Science
7 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Neurosciences
Peripheral Vascular Disease
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