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Cisternal nicardipine for prevention of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a comparative retrospective cohort study.
Vandenbulcke, Alberto; Messerer, Mahmoud; Garvayo Navarro, Marta; Peters, David R; Starnoni, Daniele; Giammattei, Lorenzo; Ben-Hamouda, Nawfel; Puccinelli, Francesco; Saliou, Guillaume; Cossu, Giulia; Daniel, Roy T.
Afiliación
  • Vandenbulcke A; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
  • Messerer M; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
  • Garvayo Navarro M; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
  • Peters DR; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
  • Starnoni D; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
  • Giammattei L; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
  • Ben-Hamouda N; Department of Intensive Care, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Vaud, Switzerland.
  • Puccinelli F; Department of Radiology, Section of Neuroradiology, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland.
  • Saliou G; Department of Radiology, Section of Neuroradiology, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland.
  • Cossu G; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
  • Daniel RT; Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland. Roy.Daniel@chuv.ch.
Acta Neurochir (Wien) ; 166(1): 133, 2024 Mar 12.
Article en En | MEDLINE | ID: mdl-38472426
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Subaracnoidea / Isquemia Encefálica / Vasoespasmo Intracraneal Límite: Adult / Humans Idioma: En Revista: Acta Neurochir (Wien) Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Austria
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Subaracnoidea / Isquemia Encefálica / Vasoespasmo Intracraneal Límite: Adult / Humans Idioma: En Revista: Acta Neurochir (Wien) Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Austria